THE  LIBRARY 

OF 

THE  UNIVERSITY 
OF  CALIFORNIA 

PRESENTED  BY 

PRO  F.CHARLES  A.  KOFOID  AND 
MRS.  PRUDENCE  W.  KOFOID 


A 

MANUAL 


CONTAINING 

RULES  FOR  DISPLAYING 

THE  STRUCTURE  OF  THE  BODY, 

SO    AS    TO    EXHIBIT 

THE  ELEMENTARY  VIEWS  OF  ANATOMY, 

AND 

THEIR    APPLICATION 

• 

TO 

PATHOLOGY  AND  SURGERY 


BY 

JOHN  SHAW, 

G    AN   OUTLINE   OF    THE    DEMONSTRATIONS 
BY   HIM    TO    THE    STUDENTS    IN   THE    SCHOOL   OF 
GREAT   WINDMILL-STREET. 


Revised  and  with  Notes  by 
WILLIAM  ANDERSON,  M  D. 


The  first  American,  from  the  last  London  Edition* 


TROY: 

PRINTED    AND  PUBLISHED   BY  J.    DISTURtfELL* 
1825, 


OGY 
LIBRARY 


Northern  District  of  Nao-YarK,  to  wit : 

BE  it  remembered,  that  en  the  eleventh  uay  o, 
June, in  the  forty-ninth  year  of  the  Indepen- 
dence of  the  United  States  of  America,  A.  D.  182o, 
JohnDisturnell,  of  the  said  district,  hath  deposited 
rf m,^  in  this  office  the  title  of  a  book,  the  right  whereol 
he  claims  as  proprietor,  in  the  words  following,  to  wit : 
'  »  A  Manual  for  the  Student  of  Anatomy.  Containing  Rules 
for  Drying  the  Structured  the  Body,  so  as  to  exhibit  the  Ele- 
mentary Views  of  Anatomy,  and  their  application  to  Patholog> 
Tnd  SuLry,  by  John  Shaw,  being  an  Outline  of  the  Demonrtra- 
VionsdeUve^d  by  him  to  the  Students  of  the  school  in  Great 
Windmill-Street.  Reused,  and  with  Notes  by  William  Aiiaei- 
son  M  D.  The  first  American,  from  the  last  London  Edition. 

In  conformity  to  the  Act  of  the  Congress  of  the  United  States., 
entitled  "  An  Act  for  the  encouragement  of  learning,  by  securing 
the  copies  of  maps,  charts,  and  books  to  the  authors .™d  propne- 
fciso&uch  copies,  during  the  times  therein  mentioned."  A ntl 
Sso  to  an  act,  entitled  "An  act,  supplementary  to  an  act,  entitled, 
<  an  act  for  the  encouragement  of  teaming,  by  securing  the  copi 

aps,  charts,  and  books  to  the  authors  and  proprietors  of 
copies  during  the  times  therein  mentioned,'  and  extending  th 
benefits  thereof  to  the  arts  of  designing,  engraving,  and   etduug 
historical  and  other  prints."  ^          LANS1NH , 

Clertcof  Gictforth&n  Diatrirt  C.wrt,  ofMti-Y'- 


55 


Page. 

INTRODUCTION,  containing  General  Rules  for  a  Student 
who  is  commencing  a  Course  of  Dissections,  xiii. 

Plan  of  a  Series  of  Dissections  of  the  Lower  Half  of  the 
Body, 

Manner  of  making  the  first  Dissection  of  the  Muscles  of 
the  Abdomen, 

Description  of  the  Anatomy  of  the  Parts  connected  with 
Hernia,  and  of  the  method  of  displaying  the  several 
Fascine  which  have  been  described  by  authors,  with 
some  observations  on  the  changes  which  those  parts 
undergo,  when  Hernia  takes  place, 

First  View  of  the  Viscera  of  the  Abdomen, 

Dissection  of  the  Diaphragm  and  deep  Muscles  of  the 
Abdomen, 

.Method  of  injecting^  and  dissecting  the^Arteries  and 
Veins  of  the  Viscera,  4£> 

Method  of  examining  the  minute  Structure  of  the  seve- 
ral Viscera,  59 

Some  observations  on  the  manner  of  examining  a  Body, 
to  discover  the  Seat  of  Disease  in  the  Abdomen,  and 
on  the  manner  of  distinguishing  the  Morbid  from  the 
Natural  Appearances  of  the  Viscera,  64 

Plan  which  the  Student  should  follow  in  the  first  Dis- 
section which  he  makes  of  the  Parts  in  the  Perineum,  6& 

.Manner  of  making  a  Section  of  the  Pelvis,  so  as  to  give 
a  general  view  of  the  Viscera,  80 

Description  of  the  Minute  Anatomy  of  the  Viscera  of 
the  Pelvis,  &c.  8:i 

Dissection  of  the  Perineum,  and  Section  of  the  Pelvis, 
to  illustrate  the  operation  of  Lithotomy,  and  to  show 
those  natural  causes  of  obstruction  to  the  introduction 
of  a  Catheter,  which  are  frequently  mistaken  for 
Stricture  of  the  Urethra,  85 

Some  observations  on  the  Changes  which  the  Viscera 
of  the  Pelvis  undergo,  in  consequence  of  disease,  80 

Table  of  the  Muscles  of  the  Perineum,  87 

-  -of  the  Arteries  of  the  Perineum,  89 


IV,  CONTENTS. 

Page. 

Manner  of  examining  the  Structure  of  the  Testicle,       ^    90 
of  making  such  Preparations  of  the  Viscera  of 

the  Pelvis  as  may  be  useful  to  the  Surgeon, 
Dissection  of  the  Parts  in  the  Pelvis  of  the  Female, 

— of  the  Uterus  and  Ovaria,  9S 

. : —  of  the  Muscles  of  the  Thigh,  100 

of  the  Muscles  of  the  Leg,  v    1 04 

i of  the  Muscles  of  the  Foot, 

Arrangement  of  these  Muscles  into  Classes, 

Table  of  the  Origins  and  Insertions  of  these  Muscles,        108 

Dissection  of  the  Ligaments  of  the  Pelvis,  and  of  the 

Joints  of  the  Lower  Extremity, 
Table  of  the  Ligaments  of  the  Pelvis, 

of  the  Hip  Joint, 

• — of  the  Knee  Joint,  1  -  ' 

. of  the  Ancle  and  Foot, 

Dissection  of  the  Arteries  of  the  Lower  Extremity, 

of  the  deep  Veins  of  the  Thigh  and  Leg, 

Table  of  the  Arteries  of  the  Pelvis;  of  the  Thigh  and 

of  the  Leg  and  Foot, 

Dissection  of  the  'Nerves  of  tho  Thigh  and  Leg, 
of  the  Superficial  Veins  and  Lymphatics  of 

the  thigh  and  Leg, 

Surgical  Dissection  of  the  Lower  Extremity,  145 

Operation  on  the  Dead  Body  to  tie  the  External  Iliac 

Artery,  146 

_ to  tie  the  Internal  Iliac,      1 49 

. to  tie  the  Gluteal  and 

Ischiatie,  & 

-  to  tie  the  Superficial  Fe- 


moral, 

Observations  on  the  Anatomy  of  Buboes, 

: Of  Lumbar  Abscess,  ib. 

Dissection  of  the  Parts  in  the  Ham,  when  there  is  Popli- 
teal Aneurism, 

Old  Operation  for  Popliteal  Aneurism,  as  performed  of 
late  years  by  the  French  Surgeons, 

To  tie  the  Posterior  Tibial  and  Fibular  Arteries, 

Dissection  of  the  Upper  Part  of  the  Body, 

Plan  of  a  Series  of  Dissections  of  this  part, 

Dissection  of  the  Brain,  so  as  to  show  each  part, 

of  the  Origin  of  the  Nerves  from  the  Brain,     171 

Dissection  of  the  Sinuses  of  the  Dura  Mater, 

Manner  of  opening  the  Spinal  Canal, 

>— —  of  examining  the  Brain,  to  discover  the  appear  <• 


CONTENTS.  V. 

Page* 

,iiioes  of  Disease,  and  to  distinguish  the  Morbid  from 
the  Natural  Changes  which  take  place  after  Death,      174 
Some  Observations  on  the  difficulty  of  deciding  on  the 

Cause  of  Death  in  supposed  Injuries  of  the  Brain,  17$ 
Dissection  of  the  Muscles  on  the  Fore  Part  of  the  Neck,  182 
Table  of  the  Origins  and  Insertions  of  the  Superficial 

Muscles  of  the  Neck, 

Dissection  of  the  Muscles  of  the  Face,  187 
Table  of  the  Origins  and  Insertions  of  these  Muscles,       18£ 
Dissection  of  the  Doep  Muscles  of  the  Neck,  191 
Table  of  the  Origins  and  Insertions  of  these  Muscles,        194 
-of  the  Muscles  be- 
tween the  Cartilages  of  the  Larynx,                                198 
Dissection  of  the  Muscles  on  the  Fore  Part  of  the  Chest,  198 
Table  of  the  Muscles  on  the  Chest,                                     190 
First  Dissection  of  the  Parts  within  the  Thorax,.              201 
Manner  of  Dissecting  the  Heart,                                         208 
Dissection  of  the  Coats  of  an  Artery,                                  211 
Manner  of  examining  the  Parts  of  the  Thorax,  to  dis- 
cover the  Seat  of  Disease,  and  to  distinguish  the 
Morbid  from  the  Natural  Appearances,                           213 
•Method  of  injecting  the  Heart  and  Great  Vessels,            221 
Structure  of  the  Mamma,                                                     224 
Dissection  of  the  Muscles  of  the  Back,                                225 
TuMe  of  the  Muscles  of  the  Back,                                      229 
~ —  of  the  Muscles  on  the  Fore  Part  of  the  Spine, 
Ligaments  of  the  Spine,                                                     234 

_ .  of  the  Jaw,  237 

— of  the  Ribs,  23§ 

between  the  Clavicles,  Sternum,  and  the 

first  Rib.  240 

Method  of  injecting  and  dissecting  the  Arteries  and  Veins 

of  the  Chest,  Neck  and  Head,  i}>. 

'fable  of  the  Arteries  in  the  Thorax,  and  of  the  Neck 

and  Head,  251 

dissection  of  the  Nerves  of  the  Neck  and  Head, — with 

Notes  on  the  Discoveries  of  Mr.  Charles  Bell,  258 

~~- — : — *of  the  Nerves  of  the  Thorax  and  Abdomen,— 
with  some  Observations  on  the  Experiments  with  Gal- 
vanism on  the  Par  Vagum,  26,2 

, of  the  Deep  Nerves  of  the  head, — with  some 

Remarks  on  Mr.  Bell's  idea  of  considering  the  Vth 
Nerve  as  a  continuation  of  the  series  of  Spinal  Nerves,  269 
Description  of  the  Portio  Dura  in  the  Elephant,  274 

Deficiency  of  the  Spinal  Accessory,  or  Superior  External 
Jiespfratorv,  in  the  Camel,  27t? 


.?  *»  CONTENTS, 

Page* 

Dissection  of  the  Parts  of  the  Nose  and  Eaiv  278 

of  the  Eye,  283 

of  the  Muscles  and  Lachrymal  Apparatus  of  the 

Eye,  29.2 

Method  of  making  certain  Preparations  of  the  Eye, 
Surgical  Dissection  of  the  Neck  and  Head,  296 

Dissection  of  the  Arm  after  it  is  separated  from  the  Body,  311 

• of  the  Muscles  of  the  Upper  Arm  and  Shoulder,  ib. 

Table  of  the  Origins  and  Insertions  of  these  Muscles,      313 
Arrangement  of  the  Muscles  on  the  Fore  Arm,  317 

Dissection  of  the  Ligaments  of  the  Shoulder  and  Arm.     322 

• — of  the  Arteries  of  the  Shoulder  and  Arm,  325 

Table  of  the  Arteries  of  the  Shoulder  and  Arm,  330 

Dissection  of  the  Veins  of  the  Arm,  333 

of  the  Nerves  of  the  Arm,  335 

Surgical  Dissection  of  the  Arm,  339 

Dissection  of  the  Lymphatics,  348 

.Description  of  the  Plans,  which  are  intended  to  illustrate 

the  new  arrangement  of  the  Nervous  System,  by  Mr. 

Charles  Bell,  nr,e 


,iD  VERT1SEMENT. 


THE  great  improvement  made  in  anato- 
my within  the  last  fifteen  years,  has  ren- 
dered necessary  something  new  in  the 
form  of  a  guide  to  the  young  practical 
anatomist';  and  minute  directions  for  the 
dissecting-room  have  always  been  receiv- 
ed with  avidity  whenever  presented. 

In  offering  this  volume  to  the  student, 
the  American  Editor  would  say,  that  he 
has  long  observed  the  insufficiency  of  the  . 
London  Dissector  to  arswer  the  queries 
made  in  the  dissecting-room;  and  had  pro- 
posed to  issue  a  new  edition  of  that  work 
.with  such  additions  as  might  be  necessary ; 
but  finding,  that  Mr.  Shaw's  Manual  had  so 
far  surpassed  anything  he  could  attempt  in 
that  form,  the  object  was  relinquished. 

This  Manual,  therefore,  is  replete  witk 
minute  anatomical  information,  followed  up 
by  useful  practical  deduction ;  so  that 


vm. 


while  it  may  lay  claim  to  the  title  of  a  sys- 
tem of  anatomy,  it  is  no  less  deserving  of 
being  considered  a  particular  account  oi 
surgical  principle. 

In  possession  of  Shawls  Manual  of  Ana- 
tomy, the  young  student  has  the  most  full 
information  concerning  the  structure  and 
relative  situation  of  important  parts,  and 
the  best  method  of  procedure  for  becom- 
ing acquainted  with  the  same  ;  while  the 
surgeon  has  always  at  hand  a  monitor  thai 
will  prepare  him  for  the  exercise  of  the 
knife  on  the  living  subject. 

Notes  have  been  added  in  situations 
where  they  were  supposed  to  extend  the 
meaning  of  the  text,  and  may  be  distin- 
guished by  a  small  italic  letter,  while  those 
0f  the  author  are  referred  to  by  an  aster- 
isk, &c. 


WHILE  engaged  in  assisting  the  students, 
in  the  dissecting-room,  I  have  been  in  the 
practice  of  drawing  up  short  notes,  con- 
taining rules  for  the  dissection  of  each  part. 
As  J  found  these  to  be  of  much  advantage 
to  myself,  and  of  great  use  to  the  students, 
I  have  been  induced,  during  the  leisure  oi 
the  summer  season,  to  arrange  them  in  a 
systematic  form. 

On  revising  them,  however,  for  the  press. 
I  perceive,  that  I  have  many  apologies  to. 
make  for  the  manner  in  which  they  are 
written:  but  I  have  some  hopes,  that  the 
inelegancies  of  the  language,  and  the  care- 
lessness of  the  style,  will  be  forgotten  in 
the  assistance  which  the  young  student 
may  derive  from  the  hints  contained  in 
them.  He  will  find,  indeed,  that  I  have 
been  indifferent  to  every  other  considera- 
tion, except  that  of  proving  useful  to  him., 
m  the  most  difficult  period  of  his  anatomi- 
cal studies, 


X.  PREFACE. 

One  object  in  the  following  pages  has 
been,  to  show  the  readiest  methods  by 
which  a  student  may  acquire,  in  the  first 
instance,  a  general  idea  of  anatomy ;  and 
secondly,  a  minute  and  practical  know- 
ledge, of  the  manner  of  exhibiting  the  struc- 
ture of  each  part. 

Another,  and  a  still  more  important  ob- 
ject, has  been,  to  direct  his  attention  par- 
ticularly, to  those  points  of  anatomy  which 
are  most  useful,  and  the  recollection  of 
which,  will  be  of  high  importance  to  him. 
when  engaged  in  the  practice  of  his  pro- 
fession. In  this  attempt,  the  student  will 
discover  many  observations  to  be  those  of 
Mr.  Charles  Bell  :  but  in  excuse  for  this, 
he  will  allow  it  to  be  difficult  for  one,  wrho 
has  either  been  Mr.  Bell's  pupil  or  assis- 
tant for  many  years,  to  write  a  work  on 
Surgical  Anatomy,  without  showing  ja  pre- 
judice in  favour  of  his  doctrines  and  man- 
ner of  teaching. 

In  giving  the  description  ofthemore  mi- 
nute parts,  I  have  taken  all  possible  assis- 
tance from  the  best  authorities ;  for  al- 
though I  have  spent  twelve  years  in  the 
dissecting-room, — during  ten  of  which,  I 
have  prepared  the  subjects  for  lecture,  and 
have  assisted  the  students,  I  still  find,  that 
no  point  of  ajuatomy  can  be  satisfactorily 


PREFACE.  X*. 

made  out,  without  referring  to  the  labours 
of  former  anatomists. 

I  have  made  much  use  of  the  "System 
of  Dissections,"  written  by  Mr.  Bell,  twen- 
ty-two years  ago,  while  a  student  in  Edin- 
burgh, and  at  a  time  when  the  opportuni- 
ties of  studying  anatomy  were  very  much 
restricted. 

may  observe,  however,  that,  notwith- 
standing the  book  was  written  under  the 
disadvantages  alluded  to,  it  is  from  it,  that 
the  f.  nonymous  author  of  the  "  London  Dis- 
scvlor"  has  taken  all  that  is  good  in  his 
Compilation.  Indeed,  both  the  plan  and 
the  object  of  the  "  System  of  Dissections,'-" 
have  been  imitated  by. all  who  have  writ- 
ten for  the  use  of  students  in  the  dissect- 
ing-room; I  am  singular,  only  in  acknow- 
ledging, that  I  have  made  free  use  of  it. 

The  observations  which  are  taken  from 
"  Pole's  Anatomical  Instructor,"  need  no 
apology,  since  they  are  my  own ;  having 
added  them,  in  the  form  of  notes,  to  the 
edition  of  that  book,  which  was  published 
eight  years  ago. 

Of  the  merits  of  this  work,  in  facilitating 
the  removal  of  the  obstacles  which  stu- 
dents encounter  in  the  commencement  of 
fheir  studies,  they  will  be  the  best  judges. 
To  their  candid  examination  I  leave  it, 


XII.  PREFACE. 

promising,  at  the  same  time,  should  an  op- 
portunity  occur,  that,  my  endeavours  shall 
not  be  wanting,  to  clear  the  obscurities, 
and  supply  the  deficiencies  which  they 
may  discover  in  the  present  edition; 

JOHN  SHAW 

.Albany  .London,  d\i%u*t  is*,  1821. 


INTRODUCTION. 


AS  it  is  allowed  that  the  sciences  of  Medicine  and  Surge- 
ry, are,  and  ought  to  be,  founded  on  Anatomy,  there  can  be 
no  occasion  to  enforce  the  necessity  of  studying1  Anatomy  ; 
still  it  may  be  necessary  to  offer  some  advice  upon  the  manner, 
in  which  a  young  surgeon  should  prosecute  the  acquirement 
of  the  knowledge  of  this  important  branch  of  science. 

When  I  entered  upon  the  study  of  my  profession,  I  was 
taught,  never  to  lose  sight  of  the  chief  end  of  anatomy;  and 
my  attention  was  directed  particularly  to  those  parts,  the  re- 
collection of  which,  would  be  of  use,  when  left  to  my  own  re~ 
sources. 

This  advice  I  would  wish  to  impress  particularly  upon  those 
students,  who,  from  circumstances,  are  not  able  to  remain 
longer  than  one  ot  two  seasons  in  London.  I  shall  even  ven- 
ture to  advise  the  student,  whose  time  is  limited,  not  to  ha- 
rass himself  in  acquiring  such  a  knowledge  of  anatomy,  as 
consists  in  a  particular  description  of  the  seven-and-twenty 
processes  of  the  sphenoid  bone,  or  the  exact  origins  and  in- 
sertions of  the  multifidiis  spinse ;  nor  to  burthen  his  memory 
with  certain  Latinized  names, — at  best  but  barbarous  com- 
binations, which  are  given  by  some  dissectors,  to  branches  of 
arteries,  in  themselves  so  small,  that,  if  cut,  they  would  not 
throw  out  more  than  one  jet  of  blood ;  and  so  irregular,  that 
they  are  seldom  seen  twice  in  the  same  relative  position. 

When  such  a  knowledge  of  anatomy  as  this,  is  considered 
to  be  of  importance,  it  is  not  surprising,  that  the  opportunity 
of  studying  what  is  truly  useful,  should  be  lost,  and  that  the 
student  should  contemn  the  science  altogether,  when  he  be- 
comes a  surgeon. — He  then  finds,  or  is  too  apt  to  consider, 
that  the  only  advantage  which  he  derived  from  the  study  of  a- 
natomy,  was,  that  it  enabled  him  to  pass  certain  examinations 

I  trust,  that  the  contents  of  the  following  pages  will  prove, 
that  notwithstanding  what  I  have  here  said,  I  do  not  intend 
to  disparage  the  knowledge  of  minute  anatomy: — on  tho 
contrary,  I  contend,  that  no  man  can  be  a  thorough  good 
surgeon,  without  that  knowledge  ;  but  it  must  be  a  very  dif 
ibrent  "minute  anatomy,"  from  that  of  being  able  to  give  the 
accurate  description  of  the  shape  and  facits  of  a  dry  bone:  or 
of  the  points,  from  which  some  deep  muscle  of  the  I 
arises,  although  expressed  even  in  that  technical  language-, 
which  appears  so  imposing  to  a  beginner. 

B 


XiV  INTRODUCTION. 

To  counteract  the  effect  of  the  long  and  hard-soundm* 
terms,  these  "  sesquipedalia  verba,"  which  unfortunately 
have  the  effect  of  leading  a  young  student  to  suppose,  that 
the  more  difficult  the  name  is  to  recollect,  the  greater  neces- 
sity there  is,  of  studying  the  part  which  it  denominates, — I 
would  advise  him,  while  he  is  engaged  in  the  dissecting- 
room,  to  read  those  hooks  on  medicine  and  surgery,  which 
are  founded  on  the  facts  of  anatomy.  By  such  a  course  of 
study,  he  will  be  directed  to  the  proper  subjects  of  inquiry ; 
and  he  will  also  have  the  best  chance  of  becoming  so  acquaint- 
ed with  the  changes  produced  by  disease,  that  he  willnotbe  in 
danger  of  being  discomposed  and  alarmed  at  their  appear- 
ance,— nor  be  obliged  to  stop  in  the  middle  of  a  perilous  ope- 
ration, should  he  find  the  parts  not  exactly  in  the  situation  as 
demonstrated  in  the  dissecting-room,  or  exhibited  on  the  ta- 
ble of  the  lecturer. 

It  would  scarcely  be  believed,  that  I  have  occasionally 
found  some  difficulty  in  impressing  the  importance  of  such 
a  course  of  study ; — a  difficulty  originating  in  an  advice  which 
is  given  by  many,  to  students,  viz.  "  not  to  read" — and  this 
upon  the  authority  of  Mr.  Hunter.  I  shall  only  ask,  What 
kind  of  anatomy  would  nine-tenths  of  the  students,  who  arc 
to  spend  only  a  short  time  in  London,  learn  ?  or  of  what  use 
would  it  be  to  them,  if  their  views  were  not  properly  direct- 
ed, by  the  study  of  good  books  ?  The  argument  in  favour  of 
not  reading,  is,  that  the  first  impressions  of  a  student  should 
be  derived  from  the  dissected  body.  With  this  opinion,  I 
most  cordially  agree ;  but  this  argument  offers  no  reason, 
why  students  should  not,  at  the  same  time,  take  advantage 
of  the  hints  contained  in  books,  written  by  those  who  have 
known  how  to  attach  the  due  degree  of  importance  to  each 
part.  Perhaps  it  will  be  allowed,  that  the  probable  conse- 
quence of  the  advice  of  not  reading,  is,  that  the  student  never 
reads  a  bookxm  the  subject,  but  is  apt  to  become  one  of  those 
self-taught  geniuses,  who,  throughout  his  life,  is  making  ab- 
surd and  fancied  discoveries  in  anatomy  and  surgery. 

I  have  often  found,  that  the  sarac  students  who  have  been 
advised  not  to  read,  have  also  been  told,  that  they  should  not 
attend  the  dissecting-room  during  the  first  season  of  their 
studies;  but,  that  they  should  acquire  their  first  ideas  of 
anatomy,  from  the  appearance  of  the  dissected  body  on  the 
lecturer's  table.  Surely  there  is  an  inconsistency  in  these 
two  opinions; — the  latter  can  never  have  been  given  by  those 
who  have  had  extensive  opportunities  of  seeing  the  course  of 
a  student's  progress. 

I  would  advise  a  student  to  attend  the  operations  in  the 
dissecting-room,  from  the  first ; — for  though  he  should  not 
uss  the  knife  himself  until  he  has  a  general  idea  of  thegtruc- 


INTRODUCTION.  XV 

lure  of  the  body,  he  will  have  an  opportunity  of  correcting 
the  erroneous  notions  which  he  necessarily  forms,  from  the 
exhibition  of  the  parts,  as  prepared  for  demonstration  on  the 
lecturer's  table;  for  he  will  discover  how  much  must  neces- 
sarily be  taken  away,  to  make  the  muscles,  arteries,  or 
nerves  sufficiently  distinct  for  public  demonstration.  But 
the  more  serious  objection  is, — that  a  student  who  delays 
commencing-  dissection  until  he  has  attended  several  courses 
of  lectures  on  anatomy,  never  makes  much  proficiency  in  it, 
nor  ever  goes  con  amore  to  his  task ;  perhaps  there  may  be  a 
moral  cause  for  this.  The  student  finds,  that  those  who 
commenced  the  study  of  anatomy,  at  the  same  time  with 
himself,  and  who  have  been,  from  the  first,  attending  the 
operations  in  the  dissecting-room,  are  much  farther  advanc- 
ed in  the  actual  knowledge  of  the  parts ;  he  is  ashamed  to 
begin,  knowing  that  his  old  companions  are  already  adroit, 
and  conscious  that  he  must  make  an  awkward  exhibition  ; — 
indeed,  I  have  frequently  found  that  .students  so  situated, 
have,  in  the  course  of  an  hour,  (to  show  somo  dexterity,) 
'finished -the"  dissection  of  a  limb;  but,  of  course,  in  a  very 
imperfect  manner. 

It  is  surely  needless  to  impress  upon  the  student,  that 
though  he  may  be  able  to  point  out  any  part  of  the  body 
which  is  exposed,  he  can  never  be  a  dexterous,  nor  even  a 
safe  operator,  unless,  he  practices  dissection:  indeed,  the 
question  of  the  propriety  of  a.- man  attempting  to  operate* 
who  has  never  dissected,  resolves  itself  simply  into  this ; — as 
an  operation  is  only  a  nice  and  difficult  dissection, — is  the 
first  essay  to  bo  made  on  the  living  body? 

I  would  recommend  the  student  not  only  to  dissect  the  im- 
portant vessels,  &c.  with  unwearied  diligence;  but  also  to 
practise  himself  in  removing  the  cellular  membrane  from  the 
larger  muscles,*  as  it  is  the  most  likely  way  of  giving  him 
that  peculiar  command  of  the  knife,  which  is  so  important 
for  a  surgeon  to.  possess,  and  which  cannot  be  attained  ex- 
cept by  much  practice. 

In  proof  of  this,  we  see  that  when  even  a  man  who  is 
naturally  dexterous,  takes  the  knife  into  his  hand  for  the  first 
time,  he  appears  awkward;  and  the  spectators  at  once  per- 
ceive, that  he  is  not  familiar  with  the  use  of  the  instrument. 

*  More  use  should  be  made  of  the  bodies  of  animals  than  is., 
generally  done.  In  a  surgical  view,  the  dissection  of  them  can 
only  be  of  use  in  giving  a  degree  of  familiarity  in  the  manage- 
ment of  the  knife  :  but  they  are  of  great  service  in  every  ques- 
tion regarding  the  minute  structure  of  a  part,  or  of  its  function,— 
nnd  particularly  in  the  investigation  of  the  nervous  system,  or  of 
tructure  of  the  organs  of  sense,  or  of  the  viscera, 


Much  of  the  appearance  of  dexterity,  and  even  real  dex- 
terity, being  dependant  on  the  manner  in  which  an  instru- 
ment is  held,  we  ought  to  study  what  is  the  best  and  neatest 
mode ;  taking  care,  however,  to  avoid  the  appearance  of  af- 
fectation.— To  perform  almost  any  dissection,  or  operation, 
the  knife  should  be  held  nearly  in  the  same  manner  as  we 
do  a  pen ;  the  motions  should  be  executed  with  the  fingers 
and  wrist  only, — for  in  this  way,  the  incisions  will  be  made 
with  more  freedom  and  precision,  than  they  can,  when  the 
shoulder,  elbow,  and  hand  are  moved  at  each  cut ;  which 
they  must,  if  the  knife  be  held  between  the  thumb  and  all 
the  four  fingers.  It  has  been  said,  that  Mr.  Hunter  used  to 
hold  his  knife  in  this  manner ;  but  on  asking  an  old  and  fa- 
vourite pupil  of  Mr.  Hunter,  and  who  is  yet  famous  for  his 
dexterity  in  operating,  and  neatness  in  dissecting,  whether 
This  was  true,  he  told  me,  that  it  was  so ;  but  that  the  joint  of 
Mr.  Hunter's  thumb  was  stiff,  inconsequence  of  an  accident. 

The  student  will  find  that  he  requires  several  instruments, 
besides  those  generally  put  into  the  dissecting  case,  to  ena- 
ble him  to  make  some  of  the  more  difficult  dissections. — 
Thus,  for  example,  he  could  not  dissect  the  nerves  of  the 
spine,  nor  of  the  head,  without  a  small  saw,  two  or  three 
cliisels  of  different  sizes,  a  small  mallet,  and  the  strong  pin- 
cers, (that  are  used  to  pull  out  nails;)  the  knife  (called  a 
hacking  knife,)which  is  used  by  plumbers  to  cut  lead,  will 
also  be  found  very  convenient.*  For  the  more  minute  dis- 
sections, he  will  require  two  small  hooks,  and  a  sharp  steel 
point ; — the  etching  tools  which  are  used  by  engravers,  are 
very  useful;  particularly  if  the  points  are  bent  a  little,  as  wo 
can  then  easily  tear  away  the  cellular  membrane  from  the 
small  nerves,  f 

It  is  perhaps*  unnecessary  to  say  that  the  student  should 
endeavour  to  prevent  the  bad  effects  of  sitting  several  hours 
in  a  cold  dissecting-room  :  the  most  effectual  way,  is,  to  put 
on  an  additional  flannel  jacket,  and  carpet  shoes  over  his 
boots.  I  would,  moreover,  advise  him,  for  the  comfort  of 
himself  and  his  friends,  to  make  a  distinct  rule,  never  to  sit 
in  the  dissecting-room,  with  the  coat  which  he  wears  through 
the  day;  but  to  keep  one  for  the  purpose  of  using  while  he 
is  there.  A  cap  should  be  worn,  in  preference  to  a  hat, 
which  is  not  only  inconvenient,  but  also  very  quickly  ac- 
quires a  bad  smell. 

*  All  these  things  may  be  got  at  a  carpenter's  tool  shop  ; — th^ 
chisels  which  are  used  for  cuttrng  iron,  are  the  best. 

t  It  is  necessary  to  have  one  or  two  coarse  cloths,  to  cover  thn 
parts  which  have  been  dissected;  as  they  very  quickly  spoil 
when  left  exposed  to  the  air. 


FIRST  DISSECTION 


MUSCLES  OF  THE  ABDOMEN. 


IT  is  not  of  much  consequence  what  part  of  the  body  the 
student  dissects  first.  I  shall  here  suppose,  that  he  is  to 
Commence  with  the  lower  half  of  the  body,  which  includes 
idl  the  parts  below  the  chest.  But  as  this  would  be  too 
much  for  one  pupil  to  accomplish,  it  should  be  taken  by  two, 
between  whom  there  ought  to  be  a  good  understanding,  as 
they  will  necessarily  interfere  with  each  other  in  their  ope- 
rations, and  particularly  in  the  dissection  of  the  viscera  of 
the  abdomen  and  of  the  pelvis. 

Before  describing  the  manner  of  making  each  dissection, 
1  shall  endeavour,  in  a  general  way,  to  point  out  the  best 
plan  of  proceeding. 

As  a  student  ought  to  acquire  only  elementary  views  of 
Anatomy  at  first,  he  should  commence'with  the  dissection  of 
the  origins  and  insertions  of  the  abdominal  muscles.  After 
having  dissected  the  muscles,  he  should  examine  the  viscera. 
Having  removed  the  viscera,  he  may  dissect  the  deep  muscles 
of  the  abdomen. 

If  the  body  be  a  male,  he  should  then  dissect  the  muscles 
of  the  perineum ;  and  having  made  himself  acquainted  with 
them,  he  ought  to  make  a  perpendicular  section  of  the  pel  vis. 
that  he  may  examine  the  parts  contained  in  it. 

The  first  dissection  of  the  thigh  and  leg  should  be  of  the 
muscles  and  ligaments  only. 

The  plan  which  the  more  advanced  student  should  follow 
is  very 'different  from  this  which  I  have  laid  down  for  the  be- 
ginner ;  I  shall  not  enter  upon  it  at  present,  but  proceed  to 
describe  the  manner  in  which  the  first  course  of  dissection  is 
to  be  prosecuted. 

DISSECTION  OF  THE  MUSCLES  OF  THE  ABDOMEN. 

The  first  observation  which  I  shall  make  upon  this  d 
tion,  is,  that  the  student  must  not  be  disheartened  if  in  his 
attempt  he  does  not  make -such  a  display  of  muscular 
' 


18 

Bbres  and  glistening  tendons,  as  he  may  sometimes  see  ex- 
hibited on  the  table  of  the  lecturer;  because  it  is  really  very 
difficult  to  make  a  neat  and  complete  dissection  of  these 
muscles. 

I  have  already  remarked,  that  the  student  must,  in  his  first 
dissection,  be  content  with  making  himself  master  of  the 
general  connections  of  the  muscles  only;  for  until  he  has 
done  this,  he  is  not  prepared  to  study  the  surgical  anatomy 
with  advantage. 

Before  commencing  the  dissection,  the  fibres  of  the  muscles 
should  be  put  upon  the  stretch  by  placing  the  body  in  a  pro- 
per position,,.  This  may  be  done  by  putting  a  large  wooden 
block  under  the  loins,  by  letting  the  legs  hang  over  the  table,, 
and  by  throwing  the  arms  towards  the  head. 

When  the  body  is  put  in  this  position,  an  incision  is  to  be 
made  through  the  integuments,  in  the  line  of  the  linea  alba* 
extending  from  an  inch  above  the  ensiform  cartilage  to  the, 
symphysis  of  the  pubes.  A  second  cut  should  commence  at 
the  upper  part  of  the  first,  and  be  carried  in  a  semicircular 
direction  over  the  chest  to  the  posterior  superior  spinous  pro- 
cess of  the  ilium.  An  incision  from  the  umbilicus  to  the  os- 
seous part  of  the  sixth  rib  will  facilitate  the  dissection.  The 
student  should  now  commence  the  dissection  of  the  first, 
muscle,  (external  oblique,)  at  the  cross  cut ;  and  as  this  is, 
supposed  to  be  his  first  attempt,  I  shall  give  a  particular  de- 
scription of  the  manner  of  proceeding.  The  cutting  edge  of 
the  knife  is  to  be  placed  perpendicular  to  the  muscular  fibres 
on  the  margin  of  the  ribs,  and  is  to  be  carried  in  the  line  of 
the  incision  towards  the  umbilicus.  The  knife  may  be  set 
boldly  on  She  fibres  of  the  muscle  which  are  between  the  ribs 
and  the  linea  semilunaris ;  but  between  this  line  and  the  um- 
bilicus much  caution  must  be  used,  as  the  muscle  forms  a 
tendinous  expansion  here,  which  is  frequently  mistaken  by 
the  young  dissector  for  cellular  membrane,  and  thus  the  ten- 
don of  the  muscle  is  improperly  lifted  and  cut  away.  In  dis- 
secting this  tendinous  part,  the  edge  of  the  knife  should  not 
be  held  perpendicular  to  the  tendon,  but  rather  in  a  slanting 
direction.  After  some  fibres  of  the  muscle  have  been  ex- 
posed in  their  whole  extent  from  the  origin  on  the  ribs  to* 
their  insertion  into  the  linea  alba,  the  forceps  may  be  laid 
aside,  and  then  with  the  finger  and  thumb  of  the  left  hand^ 
the  flap  of  skin  should  be  pulled  downwards  and  outwards,  so 
as  to  make  the  fibres  of  the  muscle  still  more  tense.  The 
dissection  is  to  be  continued,  in  the  manner  already  described^ 
down  to  the  ilium.  As  the  cellular  membrane  becomea- 
denser,  as  we  approach  the  groin,  it  maybe  mistaken  for  the 
tendon,  but  if  it  is  not  at  once  removed  with  the  skin,  it  wLft 


19 

be  difficult  afterwards  to  make  the  muscle  clean  by  dissec- 
tion with  the  forceps. 

The  upper  part  of  the  muscle  is  now  to  be  exposed.  It  is 
difficult  to  do  this  part  of  the  dissection  neatly ;  we  should, 
again  commence  at  the  cross  cut,  and  carry  the  knife  in  « 
direction  parallel  with  that  incision.  The  part  of  the  muscle 
nearest  to  the  ensiform  cartilage  must  be  dissected  with  great 
<'are,  because  it  is  very  thin,  and  is  liable  to  be  raised,  so  as 
to  expose  the  origin  of  the  rectus,  which  confuses  the  young 
dissector  exceedingly.  The  whole  of  the  external  oblique 
will  now  be  seen ;  but  to  make  its  serrated  origins  appear 
more  distinct,  a  small  part  of  the  pectoralis  major  and  latis 
simus  dorsi  should  be  dissected.  The  method  which  I  have 
now  proposed,  is  the  easiest  for  the  young  dissector ;  but  the 
student  who  is  accustomed  to  dissection  need  not  make  the- 
cross  incision  from  the  umbilicus  to  the.  semicircular  cut,  but 
may  commence  at  the  sternum,  and  carry  the  flap  down  to- 
wards the  ilium. 

I  shall  give  the  description  of  the  origin  and  insertion  of 
the  abdominal  muscles  fuller  than  those  of  any  of  the  other 
muscles,  because  I  frequently  see  the  young  student  experi- 
ence considerable  difficulty  in  showing  them.  The  obliquus 
dcscendens,  or  externus,  may  be  seen  to  arise,  by  seven  or  eight 
distinct  portions,  from  the  seven  or  eight  inferior  ribs.  Thc- 
four  or  £ve  upper  portions  mix  their  digitations  with  corres- 
ponding slips  of  the  serratus  magnus,  and  the  two  or  three 
lower  with  the  latissimus  dorsi;  sometimes  a  slip  unites  with 
the  pectoralis  major.  The  muscular  fibres  proceed  obliquely 
downwards  and  forwards,  and,  at  the  semilunar  white  liner 
terminate  abruptly  in  a  thin  tendon,  which  is  united  with  the 
muscle  of  the  other  side,  at  the  linea  alba.  The  tendon  is  so 
thin  at  the  upper  part,  that  the  muscular  fibres  of  the  rectum 
may  be  seen  through  it ; — this  is  the  part  already  described  as 
very  liable  to  be  raised  by  the  young  dissector.  While  the 
tendinous  expansions  of  the  muscles  of  each  side  are  united 
in  the  middte  of  the  abdomen,  so  as  to  form  the  superficial 
part  of  the  linea  alba,  the  more  oblique  fibres  are  inserted  into 
the  two  anterior  thirds  of  the  outer  crista,  and  to  the  anterior 
superior  spinous  process  of  the  os  ilii,  to  the  os  pubis,  and  to 
the  whole  length  of  Poupart's  ligament.  The  spermatic  cord 
in  the  male,  and  the  round  ligament  of  the  uterus  in  the  fe- 
male, may  now  be  seen  passing  between  the  tendinous  fibres- 
of  the  muscle.  This  opening  is  called  the  external  abdominal 
ring.  The  dissector  should  not  now  be  particular  in  his  at- 
tention to  it,  but  wait  until  he  makes  the  surgical  vieir,  v>  h 
will  be  afterwards  described. 


20 

We  may  now  look  to  the  general  appearance  of  the  muscle- 
First,  the  origins  of  the  muscle  from  the  side  of  the  thorax, 
come  down  in  thin  layers  over  the  rihs ;  then  a  stronger  and 
more  fleshy  part  is  seen  winding  round  betwixt  the  false  ribb- 
and the  ilium ;  the  expanded  tendon  on  the  fore  part  of  the 
belly,  is  bounded  by  the  linea  alba;  and  the  muscular  fibres 
are  divided  from  the  tendinous  part  by  the  linea  semilunaris, 
which  is  that  tendinous  white  line  which  runs,  in  a  curved 
direction,  from  the  os  pubis  to  the  margin  of  the  ribs.  In  the 
space  betwixt  the  two  lines  thorectusis  indistinctly  see  a 
through  the  semi-transparent  tendon,  and  intersected  by  white 
bands,  whicli  are  formed  by  the  union  of  its  intermediate  ten- 
lions  with  the  tendons  of  the  oblique  muscles. 

In  the  middle  of  the  linea  alba  the  remains  of  the  umbilical 
opening  will  be  seen.  It  appears  like  a  perforation  in  the 
tendons,  and  is  filled  up  by  a  dense  cellular  substance,  the  re- 
mains of  the  umbilical  vessels.  The  peritoneum  will  ..after- 
v/ards  be  found  firmly  attached  to  this  part.(a) 

To  dissect  the  next  muscie,  (internal  oblique,)  the  body 
j-hould  be  thrown  a  little  more  upon  one  side.  The  dissection 
is  to  be  begun  by  separating  the  serrated  origins  of  the  obli- 
quus  externus  from  the  ribs,  and  from  its  connection  with  the 
latissimus  dorsi.  The  external  oblique  is  then  to  be  held  as 
if  it  were  the  skin,  and  is  to  be  detached  from  the  internal,  by 
carrying  the  knife  in  a  direction  parallel  to  the  fibres  of  the 
latter,  taking  care  to  leave  the  cellular  membrane  which  lies 
betwixt  the  two,  on  the  external  muscle.  It  is  difficult  to 
separate  the  two  muscles  from  each  other  at  the  upper  part', 
farther  than  the  linea  semilunaris,  for  at  this  line  their  ten- 
dons are  united  firmly ;  but  on  the  lower  part  of  the  abdomen, 
the  whole  extent  of  the  internal  oblique  may  be  easily  shown 
by  cutting  through  the  attachment  of  the  external  oblique  to 
the  ilium  and  Poupart's  ligament.  It  is  not  easy  to  deter- 
mine which  should  be  the  origins,  and  which  the  insertions  of 
the  internal  oblique,  for  the  origin  may  occasionally  be  con- 
sidered as  the  insertion,  and  vice  versa.  Here,  we  may  de* 
scribe  it  as  arising  from  the  two-thirds  of  the  iliac  portion  of 
Poupart's  ligament ;  from  the  whole  extent  of  the  spine  of 
the  ilium;  and  from  that  fascia  formed  by  the  tendons  of  cer- 
tain muscles  of  the  back,  which  is  called  fascia  lumborum 
(this  origin  is  sometimes  described  as  from  the  lowest  lumbar 
vertebra  and  os  sacrum,  by  a  tendon,  which  also  gives  origin 

(a)  From  this  circumstance,  umbilical  herniae  by  some  authors 
have  been  considered  as  always  wanting  a  peritoneal  sac.  The 
covering  oi  these  ruptures  appears  simple;  from  the  membraiu 
being  impacted  with  the  common  integuments. 


21 

t,o  the  serratus  posticus  inferior.'}  The  fibres  which  rise  froift 
the  posterior  part  of  the  spine  or  the  ilium  run  obliquely  up« 
Wards,  to  be  inserted  by  fleshy  fibres  into  the  three  lowest 
ribs,  and  by  a  thin  tendinous  membrane  to  the  four  next  ribs. 
The  fibres  which  arise  from  the  middle  of  the  spine  run  to- 
wards the  linea  alba ;  but  at  the  linea  semilunaris  the  tendon 
splits,  and  one  portion  having  united  to  the  tendon  of  the  ex- 
ternal oblique,  runs  anterior  to  the  rectus,  and  is  inserted  to 
the  whole  extent  of  the  linea  alba — while  the  other  portion  of 
the  tendon,  which  passes  behind  the  rectus,  is  not  attached  to 
the  whole  of  the  linea  alba,  but  is  gradually  lost  about  half 
way  between  the  umbilicus  and  os  pubis ;  so  that  the  whole 
of  the  rectus  is  not  contained  in  a  sheath.  That  portion  of 
the  internal  oblique  which  arises  from  Poupart's  ligament  is 
inserted  into  the  tuberous  angle  of  the  os  pubis :  but  here 
there  is  a  set  of  fibres  which  sometimes  confuse  the  dissector ; 
they  are  seen  distinctly  in  the  male  only,  for  they  form  the 
cremaster  muscle;  they  arise  generally  from  the  internal 
oblique,  but  sometimes  from  the  ligament;  they  cover  the 
spermatic  cord,  pass  with  it  through  the  ring,  and  are  lost 
upon  the  upper  part  of  the  tunica  vaginalis  testis. 

Unless  we  are  at  liberty  to  put  the  body  into  whatever  pa* 
feition  we  please,  it  will  be  very  difficult  to  dissect  the  next 
muscle ;  and  it  will  be  almost  impossible  to  show  all  its  origins 
before  the  muscles  of  the  back  are  dissected ;  for  its  fibres 
rise  from  the  edges  of  the  eleventh  and  twelfth  ribs,  and  from 
the  transverse  processes  of  the  last  dorsal  and  the  four  supe- 
rior lumbar  vertebra;  so  that,  coming  from  this  deep  source, 
they  must  pass  between  the  quadratus  lumborum  and  sacro 
lumbalis.  Therefore,  at  present,  wre  can  show  only  the  con- 
nections which  the  transversalis  has  with  the  muscles  on  the 
anterior  part  of  the  abdomen*  We  may  commence  by  rais- 
ing the  attachments  of  the  internal  oblique  from  the  cartila- 
ges of  the  ribs,  from  the  fascia  lumborum,  and  from  the  spine 
of  the  ilium ;  but  it  is  very  difficult  to  separate  the  lower 
edges  of  the  two  muscles  from  each  other,  for  they  lie  so 
close  together,  that,  in  raising  the  attachments  of  the  oblique, 
we  are  apt  to  lift  the  transversalis  also.  The  separation  is 
most  easily  begun  at  the  spine  of  the  ilium,  for  there  is  a 
.small  artery  here,  which  marks  the  line  of  "division  between 
the  muscles.  In  this  dissection  we  must  not  expect  to  make 
the  transversalis  appear  very  clean;  for  we  must  carry  the 
knife  across  the  line  of  the  fibres. 

It  will  be  difficult  to  carry  the  obliquus  farther  than  the 
linea  semilunaris,  for  there,  the  tendons  of  the  two  muscles 
are  intimately  united.  The  tendon  of  the  transversalis  being 
•:**f  Mched  to  the  posterior  portion  of  the.  obliquus,  passes  with 


22 

it  behind  the  rectus,  from  the  ensiform  cartilage  to  a  point 
midway  between  the  umbilicus  and  pubes,  and  there  it  passes 
anterior  to  the  rectus,  with  the  obliquus,  and  is  inserted  with 
it  into  the  os  pubis ;  so  that  at  the  lower  part  of  the  abdo- 
men both  muscles  pass  anterior  to  the  rectus.  It  will  be  af- 
terwards found  that  there  is  only  a  little  cellular  membrane 
between  this  part  of  the  rectus  and  the  peritoneum.  When 
the  internal  oblique  has  been  raised  so  as  to  expose  the  whole 
of  the  transversalis,  we  shall  find  that  its  origin  and  insertion 
are  very  similar  to  those  of  the  obliquus  interims ;  but  it  is 
generally  described  as  arising  from  the  cartilages  of  the  seven 
lower  ribs,  from  the  fascia  lumborum,  from  the  transverse 
processes  of  the  last  dorsal  and  the  four  superior  lumbar  ver- 
tebrae, from  the  spine  of  the  ilium,  and  one  third  of  Poupart's 
ligament ;  the  fibres  then  pass  to  the  linea  alba  and  pubes. 

"The  muscles  which  remain  to  be  dissected  are  the  rectu? 
and  pyramidalis.  The  most  important  part  of  the  anatomy 
of  the  rectus  is  its  sheath.  It  has  already  been  seen  that  it 
is  formed  by  the  splitting  of  the  tendon  of  the  internal  oblique, 
to  the  anterior  portion  of  which,  the  tendon  of  the  external 
oblique  is  attached,  while  the  tendon  of  the  transversalis 
unites  with  the  posterior  layer.  The  rectus  itself  may  be 
exposed  by  cutting  through  the  tendon  of  the  external 
oblique  and  the  anterior  layer  of  the  internal  oblique,  at  their 
attachment  to  the  linea  alba,  but  some  difficulty  will  be  ex- 
perienced in  separating  the  sheath  from  the  belly  of  the 
muscle,  in  consequence  of  the  linear  transverse.  The  muscle 
will  be  found  at  its  lower  end  to  be  attached  to  the  symphysis 
pubis,  and  at  the  upper  to  the  ensiform  cartilage  and  the  car- 
tilages of  the  fifth,  sixth  and  seventh  ribs.  At  the  lower  part 
of  the  belly,  a  pyramidal  set  of  fibres  will  generally  be  found, 
forming  a  distinct  muscle,  called  the  pyramidalis.  It  arises 
from  the  symphysis  pubis,  and  is  inserted  into  the  linea  alba, 
about  two  inches  above  the  pubes. 

The  parts  being  thus  dissected,  can  be  demonstrated  in 
fjuch  various  views,  and  with  such  quick  succession,  that  they 
cannot  fail  to  be  effectually  understood.  And  having  care- 
fully observed  their  strict  anatomy,  no  one  can  be  at  a  IOSF 
to  recapitulate  their  general  character  and  uses. 

It  maybe  observed  in  the  skeleton  how  great  a  space  there 
is  to  be  covered  from  the  edge  of  the  thorax  to  the  brim  of 
the  pelvis,  and  backwards  to  the  spine;  and  recollecting,  that 
in  this  space  are  contained  the  soft  viscera  of  the  abdomen, 
and  that  these  must  be  sustained  by  an  elastic  and  yielding 
covering,  it  will  be  understood  how  this  covering,  whilst  it 
supports  the  viscera,  and  yields  to  and  assists  the  operations 
vif  the  diaphragm,  must  support  and  poise  the  whole  trun& 


23 

upon  the  pelvis ;  and  that  although  the  muscles  are  thin  ari 
delicate,  yet,  having  so  great  a  lever  as.  the  edge  of  the  tho- 
rax, while  the  centre  of  motion  is  in  the  spine,  they  must  bend 
the  upper  part  of  the  body  with  great  force.  We  may  now 
perceive  that  the  abdominal  muscles  are  muscles  of  respira- 
tion, that  they  are  muscles  of  the  trunk,  and  that  they  com- 
press and  retain  the  viscera.  Considering  them  as  muscles 
of  respiration,  the  student  will  be  led  to  understand  how  pe- 
culiarities in  the  manner  of  breathing  become  a  symptom  of 
disease,  and  why  we  endeavour  to  substitute  the  action  of 
these  muscles,  and  the  diaphragm,  for  the  external  muscles 
of  respiration,  in  fractures  of  the  ribs,  sternum,  &c. 

The  question,  Do  the  viscera  of  the  abdomen  suffer  an  un- 
ceasing pressure  ?  is  a  very  important  one.  When  on  this 
subject,  we  are  led  to  consider  how  the  effects  of  pressure  of 
the  abdominal  muscles  may  become  a  means  of  diagnosis  in 
diseases  of  the  abdomen  ;  and  what  are  the  effects  of  the  re- 
moval of  pressure  by  the  delivery  of  the  child,  or  the  drawing 
off  the  water  in  ascites. 

Jut  still,  the  most  important  subject  of  inquiry  in  the  dis- 
gection  of  the  abdominal  muscles,  is,"  the  anatomy  of  the 
openings  by  which  the  intestines  generally  protrude  in  ingui- 
nal or  femoral  hernia.  But  before  the  young  student  can  at* 
tend  with  advantage  to  this  subject,  he  ought  to  make  him* 
self  master  of  the  dissection  of  the  viscera  of  the  abdomen, 
and  of  the  muscles  and  arteries  of  the  thigh  However,  be- 
fore describing  those  parts,  I  shall  here  introduce  part  of  a, 
paper  which  I  published  some  years  ago,  descriptive  of  tha 
anatomy  of  hernia. 

ANATOMY  OF  HERNIA. 

It  must  have  been  remarked  by  every  one  who  has  been 
much  in  the  society  of  students,  that  there  is  no  subject^ 
which  they  are  so  anxious  to  comprehend  as  the  anatomy  of 
henna.  Those  who  have  read  much  on  the  question  before 
they  haVe  dissected  the  partb,  begin  in  utter  hopelessness  of 
understanding  the  subject;  but  if  they  be  directed  in  their 
operations,  they  will,  in  the  second  or  third  attempt,  make  an 
accurate  display  of  the  parts ;  but  still  they  will  not  be  satis- 
fied ;  they  believe  that  there  must  be  something  mysterious 
and  unusually  difficult  in  those  fascice  which  have  received 
such  various  names,  and  have  required  such  extraordinary 
descriptions.  They  cannot  imagine  how  turgeons  can  have 
puzzled  themselves,  and  bewildered  their  readers,  with  that 
which  they  now  think  they  find  perfectly  simple.  We  need 
not  be  surprised  at  this  difficulty,  since  the  descriptions  which 


24 

&re  given  by  some  authors  are  quite  at  variance  with  true 
anatomy ;  while  those  views  which  are  really  correct,  are 
given  in  so  complicated  and  obscure  a  manner,  that  it  is 
almost  impossible,  even  for  a  man  who  is  conversant  with 
the  anatomy  of  the  parts,  to  follow  them. 

In  the  best  authors  there  are  omissions,  which  have  been 
in  a  great  measure  the  cause  of  the  student's  difficulty.  A 
principal  one  is,  the  forgetting  to  describe  the  state  of  the 
body  from  which  the  views  have  been  drawn.  In  a  thin 
anasarcous  body,  all  the  fasciae  that  have  ever  been  described 
inay  be  easily  shown :  the  fascia  transversalis  will  be  so  dis- 
tinct, that  a  student,  even  in  his  first  dissection,  can  make 
out  the  internal  ring,  according  to  the  description  given  by 
Mr.  Cooper;  while  in  a  fat  subject,  this  will  be  a  difficult 
task  for  even  the  experienced  dissector. 

Unless  the  student  be  told  how  to  place  the  limb,  and  how 
to  use  the  knife  in  the  dissection  of  the  parts  concerned  in 
femoral  hernia,  it  will  not  be  possible  for  him  to  show  the 
various  crescentic  fasciae.  The  young  dissector  naturally 
proceeds  with  a  sharp  knife,  to  clear  away  the  fat,  glands, 
and  cellular  membrane,  while  the  limb  is  lying  in  a  straight 
line ;  by  doing  this,  he  cannot  avoid  cutting  through  all  the 
connections  of  the  fasciae,  so  as  to  destroy  all  resemblance  to 
those  views  which  have  been  taken  by  merely  detaching  the 
loose  cellular  membrane  and  glands  with  the  handle  of  the 
knife,  while  the  legs  were  forcibly  separated  from  each  other. 
We  shall  endeavour  to  simplify  this  piece  of  anatomy  by 
giving  an  account  of  the  manner  in  which  the  dissection  is 
made  in  the  Dissecting  Rooms  of  Great  Windmill  Street, 
and  we  shall  add,  in  the  form  of  notes,  the  names  which  have 
been  given  to  the  several  fasciae  by  the  various  authors  who 
have  written  on  the  subject. 

It  is  of  considerable  importance  in  this  dissection  to  have,  a 
good  body.  That  of  a  strong  muscular  man  is  not  so  well 
adapted  for  the  display  of  the  anatomy  of  the  groin,  as  that  of 
a  person  who  has  died  of  a  lingering  disease.  The  body  of  a 
male  is  the  best  for  the  dissection  of  the  inguinal  canal,  and 
that  of  a  female  for  the  parts  connected  with  femoral  hernia. 
The  subject  is  to  be  so  placed  that  the  abdominal  muscles 
may  be  made  tense :  this  is  most  conveniently  done  by  plac- 
ing a  block  of  wood  under  the  loins.  To  put  the  fasciae  of  the 
thigh  upon  the  stretch,  one  leg  ought  to  hang  over  the  side 
of  the  table.  The  dissection  of  the  upper  part  of  the  exter- 
nal oblique  is  to  be  made  according  to  the  general  rule  of  re- 
moving all  the  cellular  membrane  from  the  muscular  fibre; 
but  this  plan  must  not  be  followed  lower  down  than  to  a  line 
drawn  from  the  one  anterior  superior  spinous  process  o-' 


25 

tliuni  to  the  other ;  here,  the  skin  only  should  be  raised ;  i? 
may  be  carried  down  to  three  ringers'  breadth  below  the  line 
of  Poupart's  ligament.*  By  this  method  we  shall  .leave  upon 
the  groin  a  quantity  of  condensed  cellular  membrane,  between 
the  layers  of  which  is  the  arteria  epigastrica  superficialis ;  this 
membrane  may  be  traced  from  that  which  covers  the  pectora- 
lis  muscle  and  the  upper  part  of  the  muscles  of  the  abdomen ; 
it  has  generally  received  the  name  of  fascia  superficialis  coin- 
munis,  because  it  is  of  equal  importance  to  the  inguinal  and 
femoral  hernia.  This  facia  f  is  now  to  be  dissected  from  the 
tendon  of  the  external  oblique.  It  has  a  very  slight  attach- 
ment to  the  expanded  tendon,  and  the  union  between  it  and 
the  spermatic  cord  is' so  slight,  that  the  handle  of  the  knife 
can  be  pushed  between  them  as  far  down  as  to  the  bottom 
of  the  scrotum.  The  attachment  between  the  iliac!  portion 
of  Poupart's  ligament  and  this  facia  is  very  strong ;  but  the 
connection  between  the  pubic  portion  of  the  ligament  and 
the  fascia  is  so  slight,  that  the  handle  of  the  knife  is  suffi- 
cient to  destroy  it.  We  can  separate  the  fascia  with  great, 
ease  for  about  an  inch  below  the  edge  of  this  part  of  the  lig- 
ament, but  we  cannot  lift  it  farther  without  using  the  knife  ; 
for  the  fascia  becomes  intimately  united  to  the  inguinal 
glands  and  to  the  fascia  lata.  Although  we  have  raised  this 
fascia,  the  accurately  defined  pillars  of  the  abdominal  ring, 
which  are  generally  represented  in  plates  as  the  first  stage 
of  the  dissection,  will  not  yet  be  visible  ;  but  farther  dissec- 
tion will  be  required,  to  show  them ;  for  a  fascia,  which  shall 
be  presently  described,  covers  the  ring,  so  that  only  a  pro- 
minence is  seen,  and  which  we  shall  find  to  be  formed  by  the 
spermatic  cord. 

It  is  of  great  importance  to  make  this  dissection  in  the 
manner  that  has  been  pointed  out,  because  much  of  the  pa- 
thology of  femoral  hernia  may  be  explained  by  it.  By  look- 
ing narrowly  into  the  depression  which  has  been  formed  by 
raising  the  fascia  superficialis,  we  may  see  lymphatic  vessels 
passing  across  from  the  glands  to  perforate  a  membrane, 

*  Tendon  of  the  external  oblique ,  Fallopian  or  Poupart's  liga- 
ment; crural  arch ;  ligament  of  the  thigh  ;  femoral  ligament. 

t  Fascia  superficialis  of  Mr.  Cooper ;  described  by  Camper  and 
many  others  as  only  a  membranous  layer  ;  by  Scarpa,  as  a  pro- 
longation of  the  fascia  lata.  In  the  scrotum  of  the  foetus  it  forms 
the  external  lamina  of  the  peritoneum  of  Langenbeck, 

J  The  terms-iliac  and  pubic  are  better  than  external  end  inter- 
nail.    The  length  of  the  Poupart  ligament  may  be  divided  into 
three  portions  :  two  of  the  thirds  are  called  iliac,  the  other pitbic9 
b/*ibg  that  which  is  nearest  to  the  pubes, 
C 


26 

which,  though  it  appears  to  be  a  continuation  of  the  lower 
&dge  of  Poupart's  ligament,  has  been,  by  some,  described  as 
a  uistinct  fascia,  under  the  name  of  cribi^iform,  in  consequence 
of  the  appearance  which  it  presents  when  the  lymphatics  are 
cut  short.  Occasionally  a  small  gland  is  projected  through 
the  membrane.  The  general  course  of  the  femoral  hernia  is 
either  to  displace  this  gland,  or  to  break  through  the  meshes 
of  the  net-work ;  and  then  it  will  pass  into  the  hollow  which 
we  have  just  described.  The  natural  course  of  the  hernia 
would  be,  to  descend  upon  the  thigh ;  but  it  is  prevented 
from  passing  farther  down,  than  about  an  inch,  on  account 
of  the  close  connection  which  exists  between  the  fascia  su- 
perficialis and  the  glands  of  the  groin  ;  but  when  the  hernia 
increases  in  size,  as  it  is  prevented  from  descending  upon  the 
thigh,  it  turns  up  and  breaks  through  the  slight  connection 
which  there  is  between  the  pubic  pail  of  the  ligament  and 
the  fascia  superficialis,  and  thus  takes  the  place  of  an  ingui- 
nal hernia.  This  explains  to  us  that  the  acute  angle  made 
in  the  gut  is  the  principal  cause  of  stricture  in  femoral  her- 
nia ;  and  from  the  knowledge  of  this,  we  deduce  principles 
upon  which  we  must  proceed  to  attempt  the  reduction  of 
femoral  hernia,  when  so  situated.  We  must  endeavour  to 
bring  the  base  of  the  sac  to  a  straight  line  with  the  neck ; 
and  to  succeed  in  doing  this-,  we  must  first  push  the  tumour 
downwards. 

It  has  occasionally  happened  that  a  femoral  hernia  has 
passed  up  before  the  surgeon  had  finished  the  operation. 
We  have  heard  the  surgeon  blamed  for  operating  in  such  a 
Case.  It  has  been  said,  that  the  gut  going  up  before  the 
stricture  was  cut,  proved  that  there  was  no  necessity  for  the 
operation;  but  instead  of  joining  in  the  censure,  we  think 
that  it  would  be  even  advisable,  in  some  cases,  to  cut  through 
the  fascia  superficialis,  so  as  to  allow  the  sac  to  come  to  a 
straight  line,  rather  than  to  persevere  long  in  the  use  of  the 
taxis.  All  who  have  seen  many  cases  of  femoral  hernia  must 
allow,  that  a  cut  through  the  skin  and  fascia,  in  an  early 
stage,  in  many  cases,  would  not  be  so  dangerous  as  a  pro- 
tracted attempt  to  reduce  the  gut  by  the  taxis.  We  have 
further  to  consider,  that  if  it  be  not  possible  to  reduce  a  her- 
nia, after  having  cut  through  the  fascia  superficialis,  that  it 
never  would  have  been  reduced  by  the  taxis ;  in  that  case  all 
the  steps  of  the  operation  must  be  performed. 

We  now  return  to  the  anatomy  of  the  inguinal  hernia.  I£ 
we  pull  the  spermatic  cord  towards  the  scrotum,  we  shall  see 
a  thin  fascia  passing  off  from  the  tendon  of  the  external  oblique 
and  attached  to  the  cord.  It  has  been  called  fascia  propria. 
It  is  very  strong  in  cases  of  old  hernia;  but  even  in  thenatu- 


27 

ral  state  of  the  parts,  it  is  so  distinct  that  it  obscures  thejnar* 
gins  of  the  ring,  (a)  By  cutting  this  thin  fascia  where  it  is  con- 
nected with  the  cord,  and  by  letting  go  the  cord,  the  upper 
part  of  the  pillars  of  the  ring  will  be  distinctly  shown ;  but  to 
make  the  opening  of  the  ring  quite  apparent,  we  must  remove 
the  loose  fat  with  the  forceps  and  scissars  from  the  lower  part 
of  the  cord;  we  shall  then  have  such  a  view  as  is  given  in 
plates  as  the  first  stage  of  the  dissection.*  This  opening  has 
been  called  a  ring,  but  it  might  with  more  reason  be  described 
us  a  triangle,  the  base  of  which  is  the  os  pubis,  and  the  apex 
the  splitting  of  the  tendinous  fibres  of  the  external  oblique, 
and  which  is  rounded  off  by  a  set  of  cross  fibres.  The'  supe- 
rior side,  or  pillar ,  is  simply  inserted  into  the  symphysis  pu- 
bis ;  but  in  the  attachment  and  form  of  the  lower  pillar  there 
is  a  provision  to  prevent  the  compression  of  the  spermatic 
cord  during  the  contraction  of  the  muscles,  and  it  is  thus — the 
inferior  pillar  is  formed  by  the  pubic  extremity  of  Poupart's 
ligament,  which  is  not  a  rounded  tendon  that,  viewing  it  on 
?,he  outside,  we  should  expect  it  to  be,  but  it  is  so  formed  that 
part  of  it  passes  onwards  to  be  attached  to  the  linea  ileo- 
pectinea  by  a  flat  broad  horizontal  tendon,  while  its  more  ex- 
ternal part  is  inserted  into  the  tubercle  of  the  pubes;  so  that: 
by  this  form  of  insertion  there  is  a  groove  made  for  the  lodg- 
ment of  the  spermatic  cord. 

The  tendon  of  the  external  oblique  is  now  to  be  cut  through 
in  two  directions ;  one  in  a  line  drawn  from  the  superior  ante- 
rior spinous  process  of  the  ilium  to  the  linea  alba,  and  the 
other  in  the  linea  alba  to  the  pubes.  The  tendon  of  the  ex* 
ternal  oblique  is  to  be  carefully  separated  from  the  internal 
oblique,  and  is  to  be  fastened  by  a  hook  to  the  fore-part  of  the 
thigh.  This  will  give  us  a  view  of  a  great  part  of  the  inguinal 

(a]  While  the  fascia  superficialis  was  overlooked ;  Camper 
described  a  covering  to  the  cremaster  muscle,  extended  from 
the  edges  of  the  external  abdominal  ring.  This,  however, 
has -since  been  traced  in  continuation  with  the  fascia  superfi- 
cialis; is  a  part  of  that  fascia ;  and  covers  the  cremaster  as 
the  extended  aponeurosis  does  the  other  superficial  muscles 
of  the  body.  I  would  rather  retain  the  name  of  Camper's 
fascia,  to  this  slip  of  the  superficial  fascia ;  than  call  it  fascia 
propria ;  lest  it  might  be  confounded  with  the  fascia  propria. 
of  a  femoral  hernia,  that  is  derived  from  the  cribriform  por- 
tion of  the  crural  sheath. 

*  Inguinal  ring;  ring  of  the  external  oblique;  or  external 
abdominal  ring.  The  anatomy  of  the  canal  is  most  accurate- 
ly described  in  the  folio  edition  of  Mr.  Charles  Bell's  Jfecc- 
published  in  179U. 


28 

';  onaL  The  cord  will  be  seen  lying  under  the  lower  margii; 
of  the  internal  oblique,  and  so  connected  by  cellular  meln- 
brane  to  the  edge  of  the  muscle,  that  it  is  difficult  for  a  stu- 
dent in  his  first  dissection  to  tell  what  is  muscle  and  what  is 
cord.  This  is  in  a  great  measure  owing  to  the  cremaster 
muscle,  for  it  certainly  varies  considerably  in  tho  manner  in 
which  it  takes  its  origin ;  the  view  may  be  made  more  dis- 
tinct by  pulling  the  cord  in  a  direction  towards  the  scrotum, 
and  talking  off  the  cellular  membrane  from  it  and  from  the 
margin  of  the  internal  oblique.  By  doing  so,  we  shall  see 
that  the  internal  oblique  is  not  attached  to  the  whole  extent  of 
Poupart's  ligament,  but  that,  at  two  inches  and  a  half  from 
the  symphysis  pubis,  its  attachment  to  the  ligament  ceases ; 
It  then  passes,  in  the  form  of  an  arch,  to  the  tubercle,*  and  to 
the  linea  ileo-pectineaf  of  the  os  pubis,  so  as  to  assist  in  clo- 
sing the  space  behind  the  external  ring.  At  the  termination 
of  the  connection  of  the  internal  oblique  to  Poupart's  liga- 
ment, the  fibres  w^hich  form  the  cremaster  muscle  come  off; 
but  as  these  fibres  occasionally  arise  from  Poupart's  ligament, 
the  cord  sometimes  appears  to  perforate  the  internal  oblique  ;t 
but  in  the  greater  number  of  cases,  it  is  sufficiently  clear  that 
the  cord  passes  under  the  internal  oblique,  not  through  it- 
In  this  part  of  the  dissection  we  may  observe  a  nerve  running 
through  the  internal  ohlique  to  pass  on  the  cord, — it  is  the 
spermaticus  superficialis.  The  next  stage  of  the  dissection 
is  to  show  the  relation  of  the  transversalis  to  the  cord.  It 
will  be  very  difficult  to  raise  the  internal  oblique  from  the 
transversalis,  if  we  commence  the  separation  at  the  lowe^ 
edge  of  the  muscle;  but  by  cutting  through  those  fibres  of 

*  Spine  of  the  os  pubis;  tuberculum  spinosum;  tuberosity 
of  the  pubes. 

f  Linea  ileo-pectinea ;  linea  innominata,  continuous  with 
the  crista. 

|  M.  Cloquet  describes  the  cremaster  as  formed  by  some 
fibres  of  the  obliquus  internus,  which  are  pulled  down  by  the 
testicle  and  gubernaculum,  during  the  descent.  He  says  that 
these  fibres  have  two  distinct  attachments,  one  to  the  belly  of 
the  obliquus  internus,  and  the  other  to  the  os  pubis :  so  that 
each  fibre  forms  a  loop  (des  arises,)  similar  to  extensible  cords, 
which,  when  fixed  at  their  two  extremities,  are  drawn  down 
in  the  middle.  He  also  says  that  the  testicle  occasionally 
passes  through  the  substance  of  the  internal  oblique,  and 
then,  the  same  appearance  of  fibres  is  found  both  before  and 
behind  the  testicle ;  and  that  an  inguinal  hernia  in  a  female 
frequently  pushes  down  some  of  the  fibres  of  the  interna  i 
oblique  before  it,  so  as  to  form  "  un  mmcle  cremastw  accident?!. ' 


29 

the  internal  oblique,  which  are  connected  with  the  superior 
•anterior  spinous  process  of  the  ilium,  we  shall  find  some  cel- 
lular membrane,  and  a  branch  of  the  artery  called  circumflexa 
iJii,  lying1  upon  the  transversalis  muscle,  which  will  mark  the 
line  in  which  we  are  to  dissect,,  so  as  to  raise  the-  internal 
.oblique  from  the  transversalis.  The  internal  oblique  is  to  be 
separated  from  the  transversalis,  and  from  its  connection  with 
Poupart's  ligament,  as  far  as  the  origin  of  the  cremaster,  and 
it  is  then  to  be  turned  over  'towards  the  linea  alba.  The 
whole  of  the  margin  of  the  transversalis  will  now  be  seen,  and 
we  may  observe  that  its  relation  to  the  cord  is  very  nearly  the- 
name  as  that  of  the  internal  oblique ;  indeed,  the  tendons  of 
the  two  muscles  are  so  closely  connected  with  each  other,  that 
it  is  almost  impossible  to  separate  them.  It  will  be  also  ap- 
parent that  the  united  tendons  of  these  muscles,  by  their  in- 
sertion into  the  linea  ileo-pectinea,  form  the  grand  protection 
against  hernia  taking  place  through  the  external  abdominal 
.ring ;  but  when  this  part  is  weak, In  consequence  of  the  defi- 
ciency of  the  tendons,  that  hernia  which  is  called  direct,  or 
xcntro  inguinal^  may  take  place.  The  muscular  fibres  of  the 
transversalis  are  now  to  be  very  carefully  detached  from  Pou- 
part's ligament,  and  then  they  are  to  be  scraped,  not  cut. 
from  the  layer  of  condensed  cellular  membrane,  which  k 
called  the  fascia  transversalis.* 

We  have  seen  the  cord  pass  through  the  external  obliquo. 
and  under  the  margins  of  the  internal  oblique  and  transver- 
salis,— and  we  should  now  see  the  internal  ring,  described  by 
Mr.  Cooper ;  but  this  ring  must  be  made.  When  we  pull  th< 
cord  towards  the  groin,  we  see  part  of  the  cellular  membrane 
which  lies  under  the  transversalis  muscle  passing  down  upon 
it  in  a  conical  form:  If  we  cut  this  membrane  from  the  cord, 
and  push  it  up,  and  then  let  the  cord  go,  there  will  be  a  hole, 
formed  in  the  shape  of  a  ring,  but  which,  on  its  iliac  side  only, 
has  a  distinct  margin,  for  on  its  pubic  side  there  is  only  tlit *. 
.cellular  membrane  surrounding  the  epigastric  artery  and 
veins.  We  may  observe  also,  that  the  cord  at  this  point  has 
lost  its  rounded  form — that  the  vessels  are  not  bound  toge- 
ther, as  they  are  at  the  external  ring,  but  that  the  component 
,  separating  from  each  other,  give  the  cord  a  flattened 
form.  Having  now  made  an  internal  ring,(-t)  we  should  at- 

*  Fascia  transversalis,  of  Mr.  Cooper;  fascia  longitudina- 
lis,  or  reflexa,  of  M.  Cloquet ;  condensed  cellular  membrane 
between  the  peritoneum  and  transversalis  muscle,  of  many 
authors. 

(a)' This  opening  is  not  the  creature  of  the  knife,  but  exis! '<•• 
boitrc  dissection  has  commenced,  as  perfectly  as  that  on 


30 

tend  to  the  situation  of  the  epigastric  artery.  It  generally 
arises  from  the  pubic  side  of  the  external  iliac  artery,  just  be- 
fore it  passes  under  Poupart's  ligament.  It  will  be  found  to 
descend  a  little,  and  then  to  proceed  upwards  towards  the 
rectus,  passing  upon  the  pubic  edge  of  the  spermatic  cord, 
and  between  the  fascia  transversalis  and  the  peritoneum ;  it 
tnen  enters  the  substance  of  the  rectus,  about  midway  be- 
tween the  pubes  and  umbilicus.  As  this  artery  is  always  on 
the  pubic  side  of  the  spermatic  cord,  it  follows,  that  when  the 
inguinal  hernia  passes  along  the  spermatic  passage,  (which 
it  does  in  nine  out  often  cases,)  the  epigastric  artery  will  be 
on  the  pubic  side  of  the  hernia ;  but  in  the  direct  or  ventro 
inguinal  hernia,  the  artery  will  be  on  the  iliac  side. 

Let  us  now  trace  the  course  of  a  common  hernia  to  the 
scrotum,  and  show  what  coverings  it  may  have,  and  what  are 
the  probable  causes  of  stricture. 

The  muscles  and  the  peritoneum  may  be  cut  through  in 
the  usual  way  of  exposing  the  viscera,  and  the  flap  held  out  so 
that  the  inside  of  the  peritoneum,  and  the  depression  which  is 
found  at  the  part  where  the  cord  passes  into  the  canal,  may 
be  seen.  In  the  greater  proportion  of  cases,  it  is  at  this  point 
that  hernia  takes  place.  Having  laid  down  the  transversalis 
and  internal  oblique  again  in  their  natural  situations,  if  we 
push  the  finger  from  "within  downwards  into  the  depression 
of  the  peritoneum,  we  shall  exhibit  in  appearance  the  first 
stage  of  the  descent  of  a  hernia.  The  finger  is  as  the  sac 
would  be,  above  the  cord,  and  on  the  iliac  side  of  the  epigas- 
tric artery :  by  pressing  forward  the  finger,  and  through  the 
peritoneum,  it  will  appear  under  the  margins  of  the  trans- 
versalis and  internal  oblique ;  and  if  pushed  farther,  it  will 
pass  through  the  external  ring.  A  hernia  lying  at  this  point, 
would  be  called  inguinal  hernia;  but  if  it  were  to  descend  as 
far  as  into  the  scrotum,  it  would  be  called  scrotal  hernia. 
This  is  the  common  course  of  an  inguinal  hernia,  but  its  rela- 
tion to  the  cord  occasionally  varies.  When  we  look  to  the 
flattened  and  dispersed  state  of  the  cord  at  its  upper  part,  we 
can  understand  how  it  may  be  split  by  the  descent  of  a  hernia- 
ry  tumour.  In  such  a  case,  the  vas  deferens  is  sometimes 
found  on  the  anterior  part,  and  the  vessels  behind ;  but  the 
vessels  are  more  frequently  on  the  fore  part  of  the  sac. 

We  may  now  show  what  coverings  the  sac  of  a  hernia 
would  receive  in  its  passage  to  the  scrotum. 

In  the  common  inguinal  hernia,  the  peritoneum  pushes  be- 
fore it,  that  cellular  membrane  which  has  been  called  part  of 

upper  part  of  the  cone  of  a  funnel,  by  which,  the  pipe  is  con- 
jcl  with  the  body  of  the  article. 


•31 

« lie  trans versalis  fascia,  and  which  we  showed  must  be  sepa- 
rated from  the  cord  before  the  internal  ring  can  be  made ; 
this,  when  condensed,  forms  the  innermost  covering  of  the 
sac.  The  hernia  then  passes  under  the  trans versalis  and  in- 
ternal oblique,  and  as  the  cremaster  muscle  runs  from  the  in- 
ternal oblique  to  the  cord,  it  follows,  that  if  the  hernia  lies 
above  the  cord,  the  sac  must  be  between  the  cremaster  and 
the  cord ;  the  fibres  of  the  cremaster  which  lie  above  the  sac 
will  then  be  separated,  by  it,  from  each  other,  so  that  the  cel- 
lular membrane  which  connects  the  scattered  fibres,  will  form 
that  which  is  called  the  cremastic  or  spermatic  fascia.  The 
hernia  then  passes  through  the  external  ring.  In  the  early 
part  of  the  dissection,  there  was  a  membrane  shown  passing 
from  the  margins  of  the  ring  to  the  cord,  so  as  to  make  the 
ring  indistinct ;  this  membrane,  which  is  sometimes  called 
fascia 'propria,  must  also  form  one  of  the  coverings.  The 
hernia  may  now  either  lie  in  the  groin,  or  pass  into  the  scro- 
tum, and  in  either  case  it  will  be  covered  by  the  condensed 
cellular  membrane,  called  fascia  superficialis. 

If  a  patient  had  worn  a  truss  for  some  time,  all  these  fascia 
might  be  distinctly  seen  in  an  operation ;  but  it  is  of  more  im- 
portance to  recollect,  that  the  peritoneum,  which  forms  the 
.sac,  and  which,  in  its  natural  state,  is  very  thin,  would  be 
found  very  much  thickened,  and  particularly  at  the  neck  of 
the  sac;  indeed  it  is  occasionally  so  much  thickened,  that  it 
may  be  separated  into  a  dozen  layers.  But  if  it  were  neces- 
sary to  perform  an  operation  for  a  hernia  which  had  come 
down  only  a  few  hours  before, — after  having  cut  through  the 
skin  and  fat,  instead  of  finding  distinct  fasciae,  such  as  have 
been  described,  only  a  little  cellular  membrane  would  be  seen 
covering  the  sac,  and  the  sac  itself  would  be  so  thin  and  trans- 
parent, that  the  colour  of  the  gut  may  be  seen  shining- 
through  it. 

The  anatomy  of  the  fasciaB  in  congenital  hernia  is  much  the 
same ;  but  the  sac  which  is  formed  by  the  tunica  vaginalis,  is 
generally  thin  at  the  lower  part,  but  very  strong  at  the  neck. 

Before  describing  what  are  the  probable  causes  of  stricture, 
there  are  some  circumstances  to  be  recollected.  To  produce 
strangulation,  the  gut  must  be  compressed  in  the  whole  circle  ; 
strangulation  cannot  be  produced  by  the  muscular  fibres 
which  stretch  over  the  gut,  for  they  relax  occasionally ;  as, 
for  example,  when  a  patient  faints.  The  hole  through  which 
the  gut  is  pushed  is  passive;  its  diameter  is  never  diminished, 
but  the  protruded  gut  swells  and  is  increased  in  size. 

The  most  common  seat  of  stricture  in  inguinal  hernia  is  the 
external  ring ;  for  though  we  do  not  see  the  ring  until  we 
have  dissected  the  pait^  atiH  we  cm  feel  it,  even  before  the 


32 

slum  is  removed,  by  pushing  the  finger  up  along  the  cord.  If 
the  sac  has  been  opened,  if  the  external  ring  has  been  cut, 
and  the  stricture  still  continues,  what  is  the  cause  of  stricture  : 
It  cannot  be  produced  by  the  margins  of  the  internal  obliqu*: 
or  transversalis  muscles,  for  they  will  relax.  Since  we  ar<> 
told  by  high  authority,  that  the  stricture,  in  such  a  case,  is 
caused  by  the  internal  ring,  we  cannot  deny  that  it  may  occa- 
sionally happen ;  but  we  should  be  more  inclined  to  say,  that 
the  stricture  is  not  caused  by  the  internal  ring  itself,  but  by 
the  neck  of  the  sac,  which  is  situated  at  that  part.  Our  rea- 
sons for  supposing  so,  are  the  following :  In  the  dissection  of 
the  parts,  in  their  natural  or  ruptured  state,  there  is  no  inter- 
nal ring,  until  it  is  made  by  pushing  up  the  cellular  membrane 
which  surrounds  the  cord ;  and  even  then,  if  we  try  its 
.strength,  we  find  it  very  weak,  and  particularly  on  tjie  innev 
part  ;  while  the  neck  of  the  sac  is  generally  so  stros|v  that 
\vc  might  as  easily  break  a  circle  of  whip  cord  as,  tear  it- 
The  external  ring,  and  the  neck  of  the  sac,  may  be  consid- 
•as  the  most  common  scats  of  stricture ;  but  there  aro  vario 
ties,  into  the  consideration  of  which  it  would  be  impossible  to 
enter  at  present. 

There  is  a  species  of  inguinal  hernia  called  the  direct  or 
vcntro  inguinal,  which  has  been  already  mentioned  as  having 
the  epigastric  artery  on  its  pubic  side ;(«)  in  several  other  re- 
spects it  differs  from  the  common  inguinal  hernia.  It  doe," 
not  come  along  the  inguinal  canal,  but  passes  directly  through 
•the  external  ring ;  it  is  not  covered  by  the  cremaster  or  any 
part  of  the  fascia  transversalis,  but  only  by  the  fascia  proprm 
and  superficialis.(6)  The  peritoneum  is' as  liable  to  be  thick- 
ened in  this  species  as  in  the  other.  We  have  seen  in  opera- 
tion the  sac  a  quarter  of  an  inch  in  thickness.  This  kind  of 
hernia  does  not  take  place  often,  but,  in  proportion  to  our 
limited  opportunities,  it  has  occurred  to  us  more  frequently 
than  it  appears  to  have  done  to  Mr.  Cooper. 

The  dissection  of  the  parts  connected  with  femoral  hernir; 
may  now  be  made.  We  have  already  described  the  fir?' 
steps  of  the  dissection.  It  is  absolutley  necessary  that  tho 
limbs  be  kept  forcibly  separated  from  each  other.,  and  that 
the  handle  of  the  knife  only,  should  be  used  in  removing  the 
glands,  as  we  are  very  apt  to  destroy  some  of  the  coi): 
1  ions  of  the  fascia?,  if  we  use  a  sharp  knife  while  the  limb? 

(a)  Certainly  the  iliac  side ! 

(6)  By  this  expression,  the  student  would  be  led  to  expect 
that  a  scrotal  hernia  had  two  coverings  from  fascise  above  the 

aster;  while  Camper's  fascia  is  the  only  one  lyin<r 
*  ween  that  muscle  and  the  common  integuments. 


33 

&re  lying  straight.  When  the  glands  arc  removed,  w6  may 
see  the  manner  in  which  the  fascia  lata  is  connected  to  the 
Poupart  ligament ;  how  it  dips  down  towards  the  femoral 
vessels,  and  how  it  mounts  up  again  to  cover  the  pectinalis 
muscle.  The  part  of  the  fascia  lata  which  dips  down  towards 
the  femoral  vessels,  will  have  a  crescentic  form ;  but  this  will- 
not  be  so  distinct  as  is  represented  in  many  plates,  particu- 
larly in  those  of  Mr.  Hey,  unless  we  cut  through  the  con- 
nection which  there  is  between  the  fascia  lata  and  the  sheath 
of  the  vessels;  but  by  doing  so,  we  would  destroy  the  natu- 
ral view.  This  part  generally  receives  the  name  of  superfi- 
cial crescentic  arch;*  for  we  shall  afterwards  see  a  deep  one* 
It  is  in  this  stage  of  the  dissection  that  we  can  understand  how 
some  surgeons  have  described  the  femoral  hernia  as  situated 
under  the  fascia  iata,  while  others  have  described  it  as  lying- 
above  the  same  fascia ;  in  truth,  the  femoral  hernia  is  above 
one  portion  of  the  fascia  lata  and  below  another,  for  it  is  un- 
per  this  part  which  is  called  crescentic  arch,  and  above  the 
portion  which  covers  the  pectineal  muscle. 

If  we  pull  away  the  lymphatics  which  are  passing  from  the 
inguinal  glands  to  those  of  the  pelvis,  we  shall  see  a  number 
of  holes  in  a  membrane  which  connects  the  lower  edge  of  the 
Poupart  ligament  to  the  pectineal  portion  of  the  fascia  lata . 
this  part  we  have  already  noticed.  Though  it  will  not  ap- 
pear as  a  distinct  fascia  in  our  dissection,  still  it  has  received 
the  name  of  fascia  cribiformis  from  Mr.  Cooper;  and  as  an  ad- 
dition to  our  stock  of  names,  we  have,from  M.Cloquet,  septum 
crurale.  It  must  be  very  carefully  examined,  for  it  is  the 
only  weak  part  of  the  boundary  between  the  pelvis  and  the 
thigh ;  for  on  the  iliac  side  of  this  fascia  cribiformis,  Poupart's 
ligament  is  firmly  attached  to  the  fascia  lata,  and  on  its  pubic 
side  there  is  a  firm  union  between  the  edge  of  the  third  inser- 
tion of  the  Poupart  ligament  and  the  portion  of  fascia  lata 
which  covers  the  pectinalis  muscle.f 

We  now  proceed  to  the  examination  of  the  internal  view. 
The  flap  of  the  abdominal  muscles  is  to  be  held  up,  and  the 
peritoneum  is  to  be  carefully  torn  from  it;  by  which  a  useful 
view  will  be  given,  without  our  using  the  knife  at  all.  At 
about  an  inch  from  the  pubes,  we  see  a  depression,  bounded 

*  Femoral  ligament,  of  Mr.  Hey ;  falciform  process  of  the 
fascia  lata,  of  Sir.  Allan  Burns.  All  these  parts  are  accu- 
rately described  in  the  folio  edition  of  Mr.  Charles  Bell's  Dis- 
sections, published  in  1799. — He  did  not  give  them  names. 

f  While  at  this  stage  of  the  dissection  the  leg  should  be 
moved  in  different  directions,  to  show  the  effect  of  the  varioi'.--' 
positions  in  relaxing  or  tightening  the  fascite. 


34 

Tjy  the  cribiform  fascia,  through  which  the  lymphatics  pass 
into  the  pelvis  from  the  thigh.  The  part  of  Poupart's  liga- 
ment which  is  on  the  iliac  side  of  this  cavity,  is  very  firmly 
connected  with  the  fascia  which  covers  the  iliacus  internus 
muscle;  and  on  its  pubic  side,  the  united  tendons  of  th'e  in- 
ternal oblique  and  tranaversalis  muscles  are  inserted  into  the 
liuea  ileopectinea.  If  we  push  our  finger  into  this  depres- 
sion, and  force  it  through  the  cribiform  fascia,  it  will  pass 
down  into  that  hollow  on  the  forepart  of  the  thigh,  which 
lias  been  already  described  as  the  situation  in  which  a  femo- 
ral hernia  lies.  The  firm  connection  which  there  was  be* 
tween  the  fascia  superficial  and  the  glands  of  the  groin, 
would  have  prevented  us  from  passing  the  finger  farther 
down ;  but  if  we  turn  up  the  finger  as  a  hernia  does  when  it 
increases  in  size,  we  shall  find  that  it  not  only  presses  against 
the  superficial  arch,  but  that  there  is  also  a  resistance  to  it, 
caused  by  a  part  more  deeply  situated  ;  this  will  afterwards 
be  found  to  have  been  produced  by  that  which  is  called  the 
deep  crescentic  arch. 

To  show  this  deep  arch  as  a  distinct  fascia,  there  is  a  great 
deal  of  dissection  required,  and  it  may  very  justly  be  criticis- 
ed as  one  of  the  tricks  of  the  dissector ;  but  as  it  is  a  point  of 
miatomy  which  is  often  talked  of,  we  shall  describe  what  ap- 
pears to  us  to  be  the  easiest  mode  of  displaying  it.  It  may 
be  shown  on  the  same  limb  in  which  the  anatomy  of  inguinal 
hernia  has  been  seen,  but  it  would  be  better  to  have  another, 
and  then  we  may  proceed  thus : — after  having  made  the  dis- 
section of  the  external  oblique,  and  of  the  superficial  cres- 
centic arch,  in  the  manner  already  described ;  we  should 
rhold  up  the  flap  of  the  external  oblique,  and  dissect  between 
it  and  the  internal  as  far  down  as  the  edge  of  Poupart's  liga- 
ment. The  ligament  is  then  to  be  divided  into  two  lamina:, 
by  forcing  the  handle  of  a  knife  between  the  point  of  union 
of  the  external  and  internal  oblique  with  it;  by  pushing  the 
knife- to  wards,  the  thigh,  it- will  pass  under  the  fascia  lata; 
Ihon  by  moving  it  in  a  horizontal  direction  between  the 
pubes  and  ilium-,  the  external  oblique  and  fascia  lata,  which 
are  connected  together  through  the  medium  of  the  superficial 
part  of  Poupart's  ligament,  will  be  so  completely  separated 
from  the  parts  below,  that  the  ligament  will  appear  to  be 
formed  by  them  only.  But  if  we  cut  through  the  attachment 
of  the  ligament  to  the  superior  anterior  spinous  process  of 
the  ilium,  and  through  the  fascia  lata  as  far  down  as  the 
crescentic  arch  (to  save  the  parts  below,  it  is  useful  to  keep 
the  handle  of  the  knife  under  the  fascia  as  a  directory  to  cut 
upon,)  we  shall  then  have  a  view  very  similar  to  that  we 
hove  just  destroyed,  for  we  shall  see  that  the  deep  crescentic 


35 

fascia  has  nearly  the  same  form  as  the  superficial  arch.  This; 
deep  arch  may  be  described  as  being  formed,  on  the  iliac  side 
of  the  vessels,  by  a  connection  between  the  fascia  iliaca  and 
the  obliquus  internus  and  transversalis,  and  part  of  Poupart's 
ligament ;  and  on  the  pubic  side,  by  the  fascia  transversalis, 
in  union  with  the  insertions  of  the  tendons  of  the  two  mus- 
cles into  the  linea  ileo-pectinea.  But  this  we  shall  more  fully 
comprehend  by  examining  the  parts  from  within.  On  looking 
into  the  pelvis,  xve  see  the  artery  and  vein,  surrounded  by  a 
proper  sheath,  lying  upon  the  iliac  fascia,  which  is  the  name 
given  to  that  which  covers  the  iliacus  internus  and  psoas 
magnus.  If  we  hold  up  the  part  of  the  abdominal  muscles 
which  has  been  left,  and  look  under  them  towards  the  thigh, 
we  shall  see  an  opening  like  the  mouth  of  a  funnel,  into 
which  the  vessels,  surrounded  by  their  sheath,  pass.  The 
posterior  boundary  of  this  space  may  be  described  as  formed 
by  a  prolongation  from  the  fascia  iliaca,  and  from  which,  for 
a  certain  space,  the  vessels  can  be  easily  separated.  The 
anterior  boundary  may  be  traced  from  the  fascia  tranversalis ; 
being  in  fact,  that  which  is  in  close  connection  with  the  ab- 
dominal muscles,  and  forms  part  of  that  which  has  been  call- 
ed the  deep  crescentic  arch.  At  a  short  distance  below 
Poupart's  ligament,  the  fascia  iliaca  and  transversalis  become 
so  closely  connected  with  each  other,  and  with  the  cellular 
membrane  which  forms  the  sheath  of  the  vessels,  that  they 
cannot  be  traced  farther  down  upon  the  thigh. 

The  space  which  has  just  been  described  as  bounded  by 
the  fascia  iliaca  and  fascia  transversalis,  has  received  various 
names;  by  many  surgeons  it  has  been  called  the  crural 
sheath,*  by  others,  the  sheath  of  the  vessels ;  and,  conse- 
quently, when  the  latter  describe  femoral  hernia,  they  say 
that  it  passes  along  the  sheath  of  the  vessels  ;  but  this  lan- 
guage is  very  incorrect,  and  leads  to  great  confusion,  for  the 
proper  sheath  of  the  vessels  is  a  distinct  part,  formed  by  cel- 
lular membrane,  which  surrounds  them  through  their  whole 
course  from  the  sacrum  to  the  point  where  the  profunda  is 
given  off. 

M.  Cloquet  gives  the  description  of  this  part  too  much  in 
the  spirit  of  a  modern  discoverer  of  fasciae  and  rings.  He 
says,  that  we  have  here  a  part  analogous  to  the  inguinal  ca- 
nal; that  this  (the  crural  canal)  "has  a  superior  and  inferior 

*  There  is  no  crural  ring  in  the  natural  state  of  the  parts, 
but  it  may  be  felt  during  an  operation ;  and  a  distinct  ring- 
may  be  shown  in  a  preparation,  by  removing  the  whole  of  the 
herniary  sac.  Such  an  appearance  is  very  well  shown  in 
Mr.  Cooper's  plates. 


36 

opening.  The  inferior  is  the  opening  by  which  the 
passes  through  the  fascia  lata  to  enter  the  femoral  vein." 
Although  this  opening  is  represented  in  all  the  plates  of  the 
anatomy  of  the  groin,  given  by  our  own  authors,  yet  we  have 
not  described  it,  because  we  think  that  it  is  not  of  impor- 
tance in  considering  femoral  hernia, — not  on  account  of  its 
situation,  but  because  the  connection  which  there  is  between 
the  fascia  super ficialis  and  the  lymphatic  glands,  prevents  a 
femoral  hernia  from  passing  so  low  down.  There  are  no 
rases  given  by  English  authors,  of  hernias  protruding  through 
this  hole,  but  M.  Cloquet  says,  that  he  and  M.  Beclard  have 
seen  many  examples  of  it. 

We  shall  now  describe  the  layers  of  fasciae  which  may  be 
found  in  a  case  of  femoral  hernia,  and  what  are  the  most 
probable  causes  of  strangulation. 

The  sac  of  a  femoral  hernia  passes  into  the  depression, 
which,  in  the  natural  state  of  the  part?,  is  closed  by  the  crib- 
riform fascia.  We  have  seen  that  there  are  a  number  of 
holes  in  this  fascia.  One  of  these  holes  may  be  enlarged, 
vseveral  may  be  thrown  into  one,  or,  \vhat  is  more  common, 
a  small  gland,  which  is  partly  within,  and  partly  without  the 
pelvis,  may  be  pushed  forward  by  the  hernia.  The  hernia 
will  be  then  lodged  hi  the  hollow  below  the  crescentic  arch ; 
if  small,  it  may  continue  there,  but  when  it  increases  in  size, 
it  turns  up  upon  Poupart's  ligament.  The  cause  of  this,  wre 
have  already  shown.  In  its  passage  from  the  abdomen,  the 
hernia  will  have  the  epigastric  artery  on  its  iliac  side,  and  if 
the  obturator  be  given  off  by  the  epigastric,  the  probability  is, 
that  in  its  course  towards  the  thyroid  hole,  it  will  pass  over 
the  neck  of  the  sac.  The  spermatic  cord  is  so  far  removed, 
that  we  have  no  fears  for  it,  in  operation,  except  in  the  super- 
ficial incisions. 

We  shall  now  suppose  that  we  arc  operating  for  femoral 
hernia :  the  skin  is  cut  through,  and  probably  some  branches 
of  the  pudicse  externse  are  cut ;  we  then  come  upon  the  fascia 
superficialis  communis,  but  we  shall  be  very  much  mistaken, 
if  we  expect  to  see  this  in  any  way  resemble  a  distinct  fascia. 
From  the  intimate  manner  in  which  the  glands  are  united 
with  the  fascia,  it  will  appear  more  like  a  solid  mass  covering 
the  sac,  than  a  fascia ;  and  to  add  to  the  difficulty,  at  every 
scratch  of  the  knife,  branches  of  the  inguinales  going  to  the 
glands  may  bleed. (a)  If  the  hernia  be  recent,  no  distinct- 
fascia  will  be  seen ;  but  if  it  has  existed  for  some  time,  the; 
Cellular  membrane  which  has  been  pushed  down  before  the 

(a)  I  do  not  think  that  our  author  speaks  here  from 
experience  in  t&e  living  subject. 


37 

sac,  will  be  condensed  into  a  fascia,  or  rather  a  bag.  This 
has  been  called  by  Mr.  Cooper,  fascia  propria — a  term  which 
is  by  some  objected  to,  for  no  such  fascia  is  seen  in  the  dis- 
section of  the  natural  parts;  nor  has  it  ever  the  appearance 
which  we  generally  suppose  a  fascia  to  have,  for  it  not  only 
oovers  the  sac,  but  contains  it,  as  in  a  bag ;  and  in  an  opera- 
tion, it  has  so  much  the  appearance  of  a  sac,  that  we  have 
oases  given  as  examples,  of  one  portion  of  peritoneum  within 
the  other ;  for  the  surgeon  has  supposed  that  the  true  sac, 
which  'he  finds  on  opening  this  bag,  was  a  second  sac.  It  is 
.called  by  Scarpa,  the  proper  cellular  envelope  of  the  herniary 
sac,  and  by  Mr.  Charles  Bell,  the  outer  or  false  sac. 

When  the  true  sac  is  opened,  it  will  be  possible  to  bring 
•the  hernia  into  a  straight  line,  and  by  thus  doing  away  the 
acute  angle,  perhaps  the  difficulty  of  reducing  the  gut  may  be 
obviated;  but  it  will  almost  always  be  necessary  to  make  use 
of  the  bistoury.  If  we  were  now  to  consider  the  question  of 
the  seat  of  stricture,  as  a  mere  dissector  would,  we  should 
make  it  appear  very  complicated ;  but  by  taking  it  practical- 
ly, and  as  it  is  found  during  operation,  it  will  be  made  suffi- 
ciently simple. 

In  the  course  of  our  dissection,  we  saw  two  crescentic 
arches,  but  in  a  case  of  hernia  they  will  be  so  pressed  toge- 
ther as  to  appear  only  one.  Whatever  names  we  choose  to 
give  to  these  fasciae,  is  of  little  consequence  in  practice,  but 
the  recollection  that  the  part  which  causes  the  strangulation, 
is  of  a  semicircular  form,  is  of  great  importance  in  settling 
the  question, — how  is  the  stricture  to  be  cut  ? 

Some  authors  direct  us  to  cut  inwards,  some  outwards,  and 
others  upwards.  It  is  seldom  necessary  to  cut  more  than  a 
very  small  part  of  both  the  fasciso  which  we  have  just  men- 
tioned, but  if  it  be  necessary  to  cut  more,  we  ought  to  follow 
the  advice  given  by  Mr.  Charles  Bell,  to  cut  a  little  at  differ- 
ent points,  for  this  will  be  as  effectual  in  relaxing  a  circle,  as 
one  long  cut  in  any  one  direction,  and  will  not  be  attended 
with  the  same  danger. 

Students  have  been  led  into  great  confusion  by  the  use  of 
the  term  "  Gimbernat's  ligament."  It  would  appear  that  the 
greater  number  of  surgeons  who  make  use  of  this  term,  have 
taken  their  description  of  the  ligament  from  that  given  by  Mr. 
Hey.  Mr.  Hey  describes  Gimbernat's  ligament  to  be  the 
"  posteror  attachment  of  the  aponeurosis  of  the  external 
€>bli(uie  muscle. ' '  The  common  expression  in  London  is,  that 
41  Gimbernat's  ligament  is  the  third  insertion  of  Poupart's 
ligament."  Now,  it  has  already  been  shown,  that,  after  the 
whole  of  the  tendon  of  the  external  oblique  has  been  cut 
,  and,  consequently,  after  that  which  is  generally  de- 


38 

scribed  as  the  third  attachment  of  Poupart's  ligament,  that 
there  still  remains  that  deep  crescentic  fascia  which  has  been 
by  us,  perhaps  erroneously,  described  as  the  continuation  of 
the  fascia  transversalis,  which  is  sufficiently  strong  to  pro- 
duce strangulation.  Now,  if  Mr.  Key's  description  of  Gim- 
bernat's  ligament  be  correct,  here  is  sufficient  proof  that  it 
cannot  be  the  part  which  actually  causes  the  stricture. 

It  would  be  much  better  if  we  were  to  lay  aside  the  use  of 
Gimbernat's  name,  for  he  has  no  right,  from  the  merits  of  his 
publication,  to  be  considered  as  an  authority.  Though  seme 
of  his  remarks  are  very  good,  still  we  cannot  have  much  re* 
spect  for  the  anatomical  acquirements  of  a  man  who  say ?• — 
"  Were  it  not  an  expansion  of  the  fascia  lata,  which  unites 
firmly  with  the  bands  of  the  external  abdominal  ring,  and 
strengthens  their  junction,  they  would  separate,  on  the  appli- 
cation of  the  slightest  force,  as  far  as  the  spine  of  the  ilium;" 
and  in  discussing  an  operation  for  femoral  hernia,  by  Baudoti, 
in  the  Hotel  Dieu,  he  says,  "  The  spermatic  artery,  when  di- 
vided within  the  abdomen^  occasions  a  haemorrhage  very  diffi- 
cult to  stop." 

The  operation  of  Gimbernat  appears  to  have  been  suggest- 
ed by  speculations  upon  the  view  of  the  parts  in  their  natural 
state,  and  not  from  any  observation  of  the  difficulties  which 
embarrass  the  surgeon  in  his  operation.  Surely  there  cannot 
be  any  thing  worthy  of  admiration  in  his  manner  of  operating, 
for  he  most  awkwardly,  with  both  his-  hands,  introduces  his 
directory  and  bistoury  on  the  gitte"of  the  sac  next  the  pubep. 
and  runs  them  inwards,  so^a^'to  cut  up  the  attachment  of  the 
Poupart  ligament  to  t.rre  os  pubis.  He  does  not  describe  the 
danger  which  the  obturator  artery  would  be  in  frcm  this  cut, 
but  he  warns  us  to  take  care  that  we  do  not  wound  the  uterus 
or  bladder :  by  this  last  advice  he  clearly  shows  to  what  a 
depth  he  would  pass  his  knife,  and  what  a  confused  idea  he 
had  of  the  parts. 

We  may  say  in  conclusion,  that  although  the  study  of  the 
anatomy  of  the  groin  must  always  be  considered  as  a  princi- 
pal part  of  the  surgical  education  of  a  student,  still,  after  he 
has  made  himself  master,  not  only  of  the  simple  anatomy,  but 
also  of  the  confused  descriptions  of  the  parts  which  have  been 
given  at  various  times,  he  has  much  to  learn  to  make  himself 
competent  to  undertake  an  operation  for  femoral  hernia. 
Those  who  have  seen  many  operations  for  femoral  hernia, 
must  allow,  that  they  hardly  ever  saw  the  appearances  exact- 
ly similar  in  two  cases.  The  knowledge  of  all  the  circum- 
stances is  only  to  be  attained  by  watching  the  operations  of  a 
skilful  surgeon;  and  by  examining  the  diseased  parts;  and 
though  we  will  confess  that  it  is  very  difficult  fora  student. to 


39 

get  such  opportunities,  still  we  think,  that  it  is  in  his  power, 
while  prosecuting  his  studies  in  London,  to  derive  much  more 
benefit  by  examining  the  preparations  of  hernia  which  are  to 
be  found  in  Anatomical  Museums,  and  by  paying  attention  to 
the  history  of  cases  given  by  a  surgeon  well  acquainted  with 
anatomy,  than  by  endeavoring  to  follow  all  the  various  de- 
scriptions which  have  been  given  of  the  fascia." 

I  trust  that  what  I  have  said  in  this  paper  will  not  be  mis- 
construed, for -no  one  can  have  a  stronger  conviction  than  3 
have,  of  the  absolute  necessity  of  attending  to  the  natural 
anatomy  of  the  parts  connected  with  hernia.  But  while  stu- 
dents, in  consequence  of  reading  what  they  consider  the  best 
authors  on  this  subject,  are  led  to  think  only  of  the  direction 
in  which  the  stricture  is  to  be  divided,  so  as  to  avoid  wound- 
Ing  t^e  epigastric  artery  or  the  spermatic  cord,  they  are,  for 
these  supposed  dangers,  (for  there  is  hardly  a  case  on  record 
of  the  wound  of  either  of  those  parts,)  neglecting  the  conside- 
j-ation  of  questions  which  will  be  forced  upon  them  in  almost 
every  f  operation.  For  instance,  the  changes  which  take 
place  in  the  parts  superficialto  the  sac,  and  in  the  sac  itself, — 
the  difficulty  of  recognising  the  true  peritoneal  sac, — the 
.stricture  produced  by  the  neck  of  the  sac, — the  danger  of  re- 
ducing the  serum  in  the  sac,  and  leaving  the  intestine  still, 
.strangulated, — those  changes  which  take  piece  in  the  gui 
producing  strangulation, — the  difference  between  strangula- 
tion and  incarceration, — the  circumstances  which  render  an 
artificial  anus  necessary, — or  what  is  to  be  done  for  the  re- 
newal of  the  course  of  the  faeces.  Some  examples  illustra- 
tive of  these  questions,  will  be  found  in  a  paper  written  by 
me,  in  the  sixth  number  of  the  Quarterly  Journal  of  Foreign 
Medicine  and  Surgery,  February,  1820.  The  books  on  her- 
nia I  need  hardly  point  out;  but  prejudice  in  favour  of  lh<- 
history  of  operations  in  which  I  have  personally  assisted. 
'•Mids  mo  to  direct  the  student's  attention  particularly  to  the 
vases  which  are  related  by  Mr.  Charles  Bell. 

I  shall  now  proceed  to  describe  the  dissection  of  the  viscera 
of  the  abdomen,  which  I  have  already  said  ought  to  be  made 
before  the  young  student  can  attend,  with  advantage,  to  the 
•  t  vi'  hernia.   . 


40 

FIRST  VIEW 

OF  THE 

VISCERA  OF  THE  ABDOMEN 


The  first  general  view  of  the  viscera  may  be  taken  from 
the  body  on  which  the  muscles  have  been  dissected. 

Before  exposing  the  cavity  of  the  abdomen,  the  student 
should  attend  to  those  arbitrary  divisions  which  have  been 
called  the  Regions  of  the  Abdomen.  To  mark  these,  one 
line  should  be  drawn  across  the  abdomen,  between  the  most 
prominent  parts  of  the  cartilages  of  the  ribs,  and  another  be- 
tween the  superior  spinous  processes  of  the  ilia.  These  lines; 
will  divide  the  belly  into  three  parts,  each  of  which  is  subdi- 
vided. The  space  above  the  middle  line  includes  the  epi- 
gastric and  the  right  and  left  hypochondriac  regions, — thf 
cartilages  of  the  ribs  form  the  lateral  boundaries  of  the  epi- 
gastric region,  the  centre  and  upper  part  of  which  is  often 
called  scrobiculus  cordis.  If  we  take  the  umbilicus  for  a  . 
centre,  and  describe  a  circle,  the  radius  of  which  extends  to 
the  upper  and  lower  line,  we  shall  include  in  it  the  umbilical 
region;  on  each  side  of  which  is  the  iliac  region ;  and  nearer 
to  the  spine,  and  on  the  same  parallel,  are  the  lumbar  re- 
gions, or  the  loins.  Below  the  lower  line  we  have,  in  the 
middle,  the  hypogastric,  or  pubic  region,  and  on  each  side  of 
this,  there  is  an  inguinal  region. 

In  making  the  dissection  of  tha  abdomen,  to  discover  the 
cause  of  death,  we  must  have  a  regard  to  what  will  least  dis- 
figure the  body;  the  method  of  doing  this  will  be  pointed  out, 
afterwards  ;  but  in  the  present  dissection,  the  muscles  must 
be  cut^ though,  in  the  manner  best  suited  for  giving  a  gene- 
ral idea  of  the  anatomy. 

Before  cutting  through  the  peritoneum,  the  trans versalis. 
on  the  right  side,  may  be  divided,  so  as  to  expose  the  sur- 
face of  the  peritoneum ;  then,  by  insinuating  the  finger  be- 
tween the  muscle  and  the  peritoneum,  and  by  carrying  it  to- 
wards the  spine,  we  shall  be  able  to  form  some  idea  of  what 
is  meant  by  the  common  expression,  "  that  the  viscera  are 
behind  the  peritoneum,"  in  doing  this,  we  may  observe,  that 
the  surface  of  the  peritoneum  in  union  with  the  muscles,  is  of 
a  cellular  texture :  we  shall  afterwards  find  that  the  inner 
surface  is  smooth  and  serous. 


41 

'NY  e  may  now  expose  the  cavity  of  the  abdomen,  by  making 
an  incision  on  the  left  side  of  the  linea  alba,  from  the  ensiform 
cartilage  to  the  umbilicus,  and  then  from  the  umbilicus  to 
the  spine  of  the  ilium,  on  each  side:  the  lower  flap  may  be 
laid  over  the  pubes. 

The  view  of  the  viscera  now  before  us  is  most  perplexing-, 
and  has  no  resemblance  to  their  situation  in  the  living-  body ; 
indeed  it  is  impossible  to  put  any  one  turn  of  the  intestines 
into  the  relation  which  it  had  to  any  other,  while  it  was  sup- 
ported by  the  natural  and  uniform  pressure  of  the  abdominal 
muscles  in  the  living -body.  If  we  consider  what  the  condi- 
tion of  the  viscera  must  be,  when  compressed  by  the  respira- 
tory muscles,  or  when  the  body  is  in  full  action,  and  the 
viscera  are  at  the  same  time,  by  their  peculiar  peristaltic  ac- 
tion, propelling  their  contents  from  the  stomach  to  the  rec- 
tum, we  may  form  some  idea  of  what  incorrect  notions  we 
should  have  of  the  course  of  a  wound,  or  the  seat  of  disease, 
were  we  to  take  our  impressions  from  the  present  state  of 
the  viscera,  which  we  see  falling  into  almost  inextricable 
-confusion  as  soon  as  the  muscles  are  cut  through. 

These*  observations  I  have  thought  it  necessary  to  make, 
because  I  very  frequently  find  students  teasing  themselves 
with  what  they  call  "  relative  position ;" — not  only  forgetting 
that  the  position  of.  the  parts  is  changed  in  consequence  of 
death,  but  that  the  state  of  all  the  viscera,  from  the  oesopha- 
gus to  the  rectum,  varies,  according  to  their  being  full  or 
empty. 

We  may  now  proceed  to  examine  the  common  appearance 
of  the  parts  within  the  abdomen. 

When  the  abdomen  is  first  opened,  a  small  portion  of  the 
liver  will  be  seen  to  project  from  under  the  ribs  ;  part  of  the 
great  arch  of  the  stomach  will  generally  occupy  the  centre 
and  left  side.  If  the  body  be  that  of  a  young  person,  and  if 
there  have  been  no  disease  in  the  abdomen,  the  great  omen- 
turn  or  epiploon  will  extend  from  the  stomach  over  the  small 
intestines.  The  great  intestine,  or  colon,  if  distended,  wiJi 
lie  very  close  to  the  stomach ;  it  may  perhaps  be  seen  under 
the  transparent  omen-turn.  If  we  lift  up  the  omentum  from 
below,  and  turn  it  over  the  margin  of  the  ribs,  we  shall  then 
see  the  small  intestines  and  the  colon.  If  the  bladder  be  dis- 
tended, a  small  portion  of  it  will  be  visible. 

Before  examining  the  several  viscera,  we  should  attend  to 
the  inflections  of  the  peritoneum,.  It  is  difficult  for  a  young- 
student  to  understand  the  relation  which  the  peritoneum  has 
to  the  viscera ;  for  when  the  abdomen  is  laid  open,  he  is  apt. 
to  imagine  that  the  intestines  are  contained  within  the  incrn- 
,•  but  it  is  not  so :  for  if  we  trace  the  peritoneum 


42 

the  inside  of  the  transversalis  muscle,  we  may  strip  It  from 
the  back  of  the  colon ; — thus  proving,  that  this  intestine  i« 
not  surrounded  by  it.  By  a  little  care,  we  may  show  that 
the  membrane  has  the  same  relation  to  the  other  viscera* 
and  to  the  muscles  of  the  abdomen.  Hence,  the  peritoneum 
lias  been  described  as  a  loose  bag,  the  internal  surface  of 
which  has  the  character  of  a  serous  membrane,  which,  being- 
interposed  between  the  muscles  and  the  viscera,  adheres  to 
each  through  the  medium  of  its  external  cellular  surface.  It 
is  not  easy  to  show  all  the  connections  of  the  peritoneum, 
for  it  not  only  forms  a  covering  to  most  of  the  viscera,  but  also 
holds  them  in  a  certain  relative  position  to  each  other; 
whence,  some  parts  of  it  have  been  described  as  ligaments, 
as,  of  the  liver,  spleen,  colon,  small  intestines,  &c.  A  stu- 
dent may  form  a  general  idea  of  the  inflections  of  the  perito- 
neum, by  tracing  it,  from  the  inside  of  the  right  transversalis 
muscle  over  the  colon,  to  form  the  lateral  part  of  the  meso- 
oolon, — then  to  the  small  intestines,  to  form  the  mesentery, — 
and  from  them  to  the  sigmoid  flexure  of  the  colon  and  to  the 
abdominal  muscles  of  the  left  side,  from  which  it  may  again* 
be  traced  towards  the  right  side.  It  is  more  difficult*  to  trace 
the  peritoneum  from  above  downwards.  We  may  begin  to 
trace  it  at  the  diaphragm ;  from  which  it  maybe  seen  to  pass 
off  to  the  liver.  From  the  liver,  we  may  trace  it,  under  the 
name  of  the  lesser  omentum,  to  the  stomach, — then,  from  the 
stomach  to  the  arch  of  the  colon,  as  the  great  omentum.  If 
we  hold  up  the  colon,  we  shall  be  able  to  trace  the  perito- 
neum, from  the  surface  of  the  gut  towards  the  spine,  as  the 
mesocolon,  or,  as  it  is  sometimes  called,  "  the  ligament  ol" 
the  colon,"  and  which  is  needlessly  divided  into  two  portions, 
called  "  right  and  left  mesocolon."  From  the  lower  part  of 
the  mesocolon,  we  may  trace  it  to  form  the  mesentery  of  the 
small  intestines.  From  this  it  passes  down  to  the  rectum, 
and  here  it  is  called  "the  mesorectum."  In  the  female,  we 
may  trace  the  membrane  to  the  uterus,  to  form  the  ligament* 
of  this  viscus,  and  then,  as  the  plica  semilunaris,  to  the  blad- 
der ;  from  which,  as  in  man,  we  may  again  trace  the  perito- 
neum to  the  muscles  of  the  abdomen, — and,  so,  round  to 
where  we  began.* 

*  I  shall  here  enumerate  certain  parts  of  the  peritoneum, 
whicli  have  not  yet  been  mentioned ;  the  student  will  have 
no  difficulty  in  discovering  them,  without  any  further  de- 
scription— ligamentum  dextrum  venlriculi;  the  vinculum  oeso- 
phagi ;  vinculum  inter  cesophagum  et  lienem  ;  plica  renalis  et 
"ctpsularis ;  plica  d  rene  ad  colon  ;  plica  duodeno  renalis ;  plica 
*'pa*ico  wnak.  When  the  lower  part  of  the  muscles  of  the 


43 

The  principal  difficulty  in  following  the  inflections  of  the 
peritoneum,  is  owing  to  the  great,  or  gastro-colic,  omentum, 
the  lamina  of  which  have  been  always  matter  of  great  an- 
noyance to  the  student.  If  the  omentum  be  not  thickened 
by  disease,  it  will  be  seen  running  from  the  stomach  down 
nearly  to  the  pelvis;  and  if  it  be  lifted  up,  it  will  be  found 
attached  to  the  arch  of  the  colon.  If  the  colon  had  been  far 
removed  from  the  stomach,  then  the  omentum  would  have 
appeared  more  simple ;  for  in  this  case,  we  might  have  traced 
one  layer  from  the  upper,  and  another  from  the  lower  surface 
of  the  stomach,  to  the  corresponding*  parts  of  the  colon;  but 
as  the  colon  lies  close  upon  the  stomach,  and  as  the  omentum 
is  of  a  great  length,  it  is  necessarily  reflected  back  upon 
itself  to  pass  to  the  colon,  so  that  below  the  line  of  the  colon, 
the  two  layers  of  the  omentum  must  be  doubled,  and  hence  it 
may  be  said  that  the  loose  portion  of  the  omentum  which 
covers  the  small  intestines  is  formed  of  four  laminae. * 

The  young  student  is  not  less  puzzled  by  the  descriptions 
which  are  generally  given  of  the  bag  of  the  omentum  and 
the  foramen  of  Winslow, — perhaps  the  difficulty  will  be  les- 
sened if  he  examines  the  parts  in  the  following  manner: 

In  pulling  the  stomach  down  from  the  liver,  the  lesser 
omentum  or  mesogastrium  will  be  seen :  and  in  doing  this, 
the  vessels  which  are  passing  to  and  from  the  liver  may  be 
seen  or  felt ;  these  vessels  are  surrounded  by  the  peritoneum 
-and  a  portion  of  cellular  membrane,  and  as  this  was  de- 
scribed by  Glisson  as  bearing  some  resemblance  to  a  capsule, 
it  has  been  called  the  capsule  of  Glisson.  If  the  finger  be 
put  under  these  vessels  on  the  right  side,  it  will  pass  under 
the  ligamentum  hepatico  duodenale,  and  into  the  foramen  of 
Winslow,  which  is  the  opening  of  the  great  bag  of  the  omen- 
turn,  the  boundaries  of  which  may  be  traced  in  the  following 
manner : — If  we  push  the  finger  towards  the  left  side,  it  will 
be  seen  under  the  omentum  minus ;  if  farther,  it  will  pass 

abdomen  are  cut  from  the  umbilicus  to  the  ossa  ilii,  three 
lines  will  be  seen  on  the  peritoneum, — the  central  one,  from 
the  fundus  of  the  bladder  to  the  umbilicus,  is  formed  by  the 
part  which  in  the  foetus  was  called  "urachus;"  and  the 
two  lateral  lines  are  formed  by  the  remains  of  the  umbilical 
arteries.  These  parts  are  external,  but  adhere  so  closely  to 
the  peritoneum  in  the  adult,  as  to  appear  to  be  produced  by 
a  thickening  of  the  membrane. 

*  The  portion  of  the  great  omentum  which  runs  towards  the 
usseumis  called  "  omentum  caeci ;"  this  is  quite  different  from 
.the  appendices  epiploicce,  which  are  found  on  the  colon,  and. 
which  are  sometimes  called  "  omentults  intestini  crassi." 


44 

'under  the  stomach;  if  we  try  and  push  it  backwards,  it  \vjji 
be  stopped  by  the  pancreas  and  the  parts  lying  on  the  spine ; 
if  wre  pass  it'in  a  direction  downwards,  it  will  be  obstructed 
by  the  mesocolon,  and  if  upwards,  by  the  liver ;  but  if  there 
be  no  adhesions  formed,  we  shall  be  able  to  pass  it  up  be- 
t  ween  the  stomach  and  colon,  into  the  space  between  the 
tluplicature  of  the  omentum,  which,  in  a  young  body,  may  be 
distended  so  as  to  appear  like  a  bag,  by  blowing  with  a  pair 
uf  bellows  into  the  foramen  of  Winslow. 

When  the  omentum  is  dissected  from  the  stomach  and  co- 
lon, the  viscera  will  appear  very  confused  ;  but  by  a  little 
management,  the  parts  may  be  unravelled.  Look  in  the 
right  iliac  region  for  the  termination  of  the  small "  intestine 
(the  ileon)  in  the  great  intestine  (the  colon;)  make  a  small 
opening  in  the  ileon,  about  six  inches  from  the  colon;  intro- 
duce a  blow-pipe,  and  blow  towards  the  colon : — the  colon 
being  distended,  will  be  seen  with  its  membrane  (mesocolou^ 
to  form  a  natural  division  in  the  abdomen,  all  the  small  in- 
testines being  below,  and  the  stomach,  &c.  above  it.  When 
the  colon  is  distended,  we  can  understand  the  terms  which 
ure  given  to  its  several  parts,  viz.  caput ;  ccecum  ;  processuv 
rcrmiformis;  ascending  part  of  the  arch;  transverse  part  of 
t ke  arch  ;  descending  part ;  and  si gmoid flexure. 

The  small  intestines  are  seen  lying  in  a  confused  mass 
within  the  embrace  of  the  colon :  to  unravel  them,  the  blow- 
pipe should  again  be  put  into  the  lower  part  of  the  ileon; 
and  then  by  blowing  upwards,  the  whole  of  the  intestinum 
tenue,  or  small  intestines,  will  be  distended.  The  upper  part, 
which  will  be  now  easily  found,  should  be  tied  just  before  it 
passes  under  the  mesocolon. 

The  small  intestines  are  generally  divided  into  five  part?, 
three  of  wiiich  are  given  to  the  upper  portion,  which  is  called 
jejunum,  and  two  to  the  lower,  viz.  the  ileon.  The  arteries 
seen  in  this  view,  are  all  branches  either  of  the  superior  or 
inferior  mesenteric.  The  email  intestines  may  now  be  re- 
moved from  the  mesentery,  by  cutting  all  that  is  between  the 
3igature  on  the  ileon,  and  that  on  the  jejunum. 

We  may  now  examine  the  viscera  above  the  line  of  the 
colon.  If  the  blow-pipe  be  introduced  into  the  remaining- 
part  of  the  jejunum,  the  air  will  distend  the  duodenum  and 
the  stomach.  The  colon  is  to  be  pulled  downwards,  and  is 
then  to  be  removed  by  dissecting  away  the  mesoeolon  from 
the  parts  below  it;  by  doing  so,  we  shaH  get  a  view  .of 
the  liver,  the  stomach  and  spleen,  the  dmodenum  and  pan- 
creas. If  we  pull  down  the  stomach,  we  shall  see  the  oeso- 
phagus coming  through  the  diaphragm,  and  entering  the 
fiac  orifice  of  the  stomach ;  upon  its  left  side  we  e&ul  see- 


45 

Oie  spleen,  attached  by  a  set  of  small  vessels.  Tracing  the 
arch  of  the  stomach  downwards,  we  come  to  the  pylorus ;  by 
taking  this  between  the  finger  and  thumb,  we  shall  discover 
a  thickening  of  the  coats  of  the  stomach,  which  forms  the 
sphincter  of  the  pylorus,  improperly  called  a  valve.  Imme- 
diately below  the  sphincter,  is  the  beginning  of  the  duode- 
num; this  gut  appears  generally  so  large,  as,  from  its  size,  to 
entitle  it  to  the  name  of  ventriculus  secundus ;  it  may  be 
traced  up  towards  the  gall  bladder,  and  then,  taking  an 
irregular  turn  upon  itself,  it  passes  towards  the  left  side, 
across  the -spine;  at  the  point  where  it  is  passing  over  the 
spine,  we  see  that  is  bound  down  by  the  mesocolon, — and 
here  we  may  also  observe,  that  the  peritoneum  does  not  so 
entirely  cover  it  as  it  does  the  other  intestines.  The  most 
important  parts  which  we  have  to  attend  to  in  the  duodenum 
are  the  ducts  which  pass  into  it.  The  edge  of  the  liver  may 
now  be  held  up  by  an  assistant,  that  we  may  haVe  a  view  oY 
the  gall  bladder,  and  of  those  vessels  and  ducts  which  are 
-contained  within  the  capsule  of  Glisson.  On  holding  up  the 
liver  in  this  manner,  we  shall  understand  the  derivation  of 
the  name,  porta,  for  the  part  of  the  liver  into  which  those 
vessels  are  passing,  has  something  of  the  form  of  a  gateway; 
whence  the  name  vena  portce  has  been  given  to  the  principal 
vessel  of  the  liver. 

When  the  arteries  and  veins  are  injected,  there  will  be  no 
difficulty  in  discovering  the  several  parts  ;  but  even  in  the 
umnjected  state,  they  will  be  easily  found,  by  merely  taking 
off  the  cellular  membrane  investing  them.  The  vessel  on 
the  left  side  will  be  the  hepatic  artery  ;  the  large  vessel  in 
the  middle  is  the  vena  portae ;  the  ductus  communis  choledo- 
chus is  on  the  right  side,  and  will  be  known  by  its  dusky  yel- 
low colour.  It  will  be  easy  to  trace  from  this,  the  ductus 
Cysticus  ;  into  which  such  a  hole  is  to  be  made  as  will  admit 
a  blow-pipe :  by.  blowing  towards  the  liver,  the  gall  bladder 
will  be  distended ;  and  by  blowing  in  the  other  direction,  we 
shall  distend  the  hepatic  ducts,  and  the  ductus  communis 
choledochus:  by  which  the  dissection  will  be  facilitated. 
Perhaps  a  better  mode  of  distending  these  parts  will  be,  to 
make  a  very  small  puncture  into  the  upper  part  of  the  gall 
bladder;  from  which  the  bladder  and  ah1  the  ducts  maybe  a\ 
once  injected  or  filled  with  air. 

The  cellular  membrane  is  now  to  be  carefully  taken  of!' 

from  the  pancreas,  so  as  to  expose  the  duct,  which  is  like  a 

vein,  but  of  a  whiter  colour;  it  runs  into  the  duodenum,  close 

to  the  ductus  communis  choledochus.     A  second  duct  of  the 

ea?  will  be  generally  found  coming  from  that  part  of  the 


46 

irfand  which  is  called  the  head,  and  which  adheres  closely  to 
the  duodenum. 

Before  separating  the  liver  from  the  diaphragm,  the  liga- 
ments should' be  observed: — 1st.  the  round  ligament,  or  the 
remains  of  the  umbilical  vein ;  2d.  the  broad,  or  suspensory 
ligament  formed  by  the  peritoneum  passing  from  the  mus- 
cles of  the  abdomen,  and  from  the  diaphragm;  3d.  the  coro- 
nary ligament,  being  the  attachment  of  the  liver  to  the  dia- 
phragm, through  the  medium  of  the  peritoneum;  and  4th  and 
5th,  the  two  lateral  ligaments,  which  are  only  the  right  and 
left  extremities  of  the  coronary  ligament.  In  separating  the 
viscera  from  the  abdomen,  if  we  cut  through  the  round  and 
suspensary  ligaments,  the  liver  will  be  retained  only  by  the 
coronary  ligament ;  in  cutting  this  last  ligament,  we  must 
also  divide  the  venas  cavse  hepatica?.  In  removing-  the 
stomach,  the  (esophagus  must  be  pulled  down ;  but  it  should 
be  tied  with  a  double  ligature  before  it  is  cut. 

The  pancreas,  &c.  will  also  be  easily  separated  by  cutting- 
through  a  Tew  vessels,  and  a  little  cellular  membrane.  The 
viscera  may  be  put  into  water,  for  future  examination. 

We  may  now  show  the  muscular  fibres  of  the  diaphragm, 
by  taking  oif  the  peritoneum  which  covers  it ;  but  in  doin<r 
this,  we  must  avoid  cutting  through  the  diaphragm,  or  the 
air  will  rush  into  the  chest,  and  the  diaphragm  will  fall,  re-r 
laxed.  We  should  observe  the  three  openings  in  the  dia- 
phragm, viz.  the  central  one,  between  the  crura,  for  the 
aorta  and  thoracic  duct ;  the  right,  or  tendinous  one,  for  the 
vena  cava  (which  vessel  has  propably  been  torn,  in  pulling 
away  the  liver ;)  and  on  the  left  side,  the  hole  for  the  oeso- 
phagus. 

The  only  viscera  now  remaining,  are  the  kidneys  and 
their  appendages.  There  are  but  few  observations  neces- 
sary to  be  made  on  them  at  present,  as  they  will  be  describ- 
ed in  the  dissection  of  the  vessels  of  the  abdomen ;  the  young 
dissector  should  only  look  to  their  general  situation,  and  ob- 
serve, that  in  consequence  of  the  quantity  of  fat  and  cellular 
membrane  which  covers  them,  they  are  not  clo&ely  invested 
by  the  peritoneum,  as  the  chylopoetic  viscera  are;  and  there* 
lore,  they  are  generally  described  as  being  situated  without 
ihe  peritoneum.  The  kidneys  may  now  be  removed,  that 
we  may  complete  the  first  general  dissection  of  the  abdomen 
by  showing  the  course  of  the  deep  muscles,  viz,  the  quadra- 
tus  lumborum,  psooe,  and  ilacus  internus.  The  cellular  mem- 
brane covering  these  muscles  is  very  loose,  and  easily  re- 
moved ;  the  small  vessels  and  nerves  which  run  upon  them 
may  be  cut  through,  but  the  aorta  should  be  preserved.  At 
the  upper  part  of  the  quadratic  a  strong  ligament  will  be  seen 


47 

running  from  the  extremity  of  the  last  rib,  to  the  transverse 
process  of  the  first  lumbar  vertebra :  this  is  the  ligamentum 
arcuatum.  Upon  the  ihacus  and  psoas  there  is  a  strong 
fascia,  which  is  also  closely  united  to  the  Poupart  ligament. 
To  trace  the  muscles  to  their  insertion,  this  fascia  should  bo 
cut  through;  but  at  present  we  should  not  follow  them  to 
the  trochanter,  for  by  this,  we  should  destroy  some  of  the 
muscles  of  the  thigh. 

ORIGIN  AND  INSERTION  OF  THE  DIAPHRAGM.  The.  dia^ 
phragm  is  a  broad  thin  muscle,  which,  with  its  tendon,  make# 
a  complete  transverse  septum  or  partition  betwixt  the  thora> 
and  abdomen ;  it  is  concave  downward  and  convex  upward  -, 
the  middle  of  it,  on  each  side,  reaches  as  high  within  th« 
thorax  as  the  leyel  of  the  fourth  rib. 

The  diaphragm  is  generally  described  as  consisting  of  two 
muscles  and  an  intermediate  tendon. 

THE  SUPERIOR  OR  GREATER  MUSCLE  OF  THE  DIAPHRAGM. 
OR.  By  distinct  fleshy  fibres :  1 .  from  the  cartilago  ensifor- 
mis ;  2.  from  the  cartilages  of  the  seventh,  and  of  all  the  in- 
ferior ribs  on  both  sides,  and  ligamentum  arcuatum. 

IN.  From  these  origins,  the  fibres  run  radiated  from  the 
circumference  to  the  centre  of  the  septum,  and  terminate  in 
a  cordiform  tendon,  which  forms  the  middle  of  the  diaphragm, 
and  in  which  the  fibres  from  the  opposite  sides  are  inserted 
and  interlaced.  To  the  right  of  this  tendinous  centre  there 
is  a  perforation  for  transmitting  the  vena  cava. 

THE  INFERIOR  OR  LESSER  MUSCLE  OF  THE  DIAPHRAGM, 
OR.  The  second,  third,  and  fourth  lumbar  vertebrae,  by  sev- 
eral tendinous  heads,  of  which  the  central  and  longest  are 
called  the  crura.  (Between  the  crura,  the  aorta  and  tho- 
racic duct  pass:  and,  on  the  outside  of  these,  the  great  sym- 
pathetic nerves  and  branches  of  the  vena  azygos  perforate 
the  shorter  heads.)  The  fibres  run  upwards,  and  form,  in 
the  middle,  two  fleshy  columns,  which  decussate,  and  leave 
an  oval  space  between  them  for  the  passage  of  the  oesopha- 
gus and  eighth  pair  of  nerves. 

IN.  The  back  part  of  the  central  tendon  of  the  diaphragm, 
USE.  The  diaphragm  is  the  principal  muscle  of  respira* 
tion :  when  it  is  in  action,  the  fibres  bring  the  septum  to- 
wards a  plane,  by  which  the  cavity  of  the  thorax  is  enlarged ; 
when  relaxed,  it  is  pressed  by  the  abdominal  muscles,  which, 
acting  through  the  viscera,  thrust  it  up,  and  compress  tin* 
Imgs. 


48 

QUADRATUS  LUMBORUM.  OR.  From  the  posterior  pai^ 
of  the  spine  of  the  os  ilium. 

IN.  Into  the  transverse  processes  of  all  the  lumbar  verte- 
brae ;  into  the  last  rib  near  the  spine  ;  and,  by  a  small  tendon, 
into  the  side  of  thelasi  vertebra  of  the  back. 

USE.  To  move  the  loins  to  one  side ;  to  pull  down  the  last 
rib;  and  when  the -muscles  of  both  sides  act,  "to  bend  the 
loins  forward. 

PSOAS  PARVUS.  On.  The  sides  of  the  two  upper  verte- 
brae of  the  loins.  Sends  off  a  small  long  tendon,  which  ends 
thin  and  flat,  and  is 

IN.  Into  the  iliac  fascia  and  Poupart's  ligament. 

USE.  To  strengthen  the  insertion  of  the  abdominal  mus- 
des,  and  prevent  their  yielding  in  the  straining  of  the  mus- 
cles of  the  trunk.  This  muscle  is  often  wanting. 

PSQAS  MAGNUS.  OR.  1.  The  body,  and  transverse  pro- 
cess of  the  last  vertebra  of  the  back ;  2.  from  all  those  of 
the  loins. 

IN.  The  trochanter  minor  of  the  thigh  bone ;  and  into 
that  bone  a  little  below  the  trochanter. 

USE.  To  bend  the  thigh  forwards,  or,  when  the  inferior 
extremity  is  fixed,  to  assist  in  bringing  the  body  forward. 

ILIACUS  INTERNUS.  OR.  1.  The  transverse  process  of 
the  last  vertebra  of  the  loins:  2.  all  the  inner  lip  of  the  spine 
®f  the  ilium ;  3.  the  edge  of  that  bone,  between  its  anterior 
superior  spinous  process  and  the  acetabulum;  4.  from  most 
of  the  hollow  part  of  the  ilium.  It  joins  with  the  psoas  mag-- 
nus,  where  it  begins  to  become  tendinous,  and  is 

IN.  Into  the  lesser  trochanter. 

USE.  To  assist  the  psoas  magnus. 


DISSECTION 

OF  THE 

ARTERIES  dJYD  VEWS  OF  THE 
VISCERA. 


IP  the  student  does  not  intend  to  examine  the  minutr- 
Structure  of  those  viscera  which  he  has  removed  from  the- 
"body*  he  should  now  proceed  to  dissect  the  muscleB  of  fte- 


19 

?  high,  or  of  the  perineum,  if  it  be  a  male  body.  But  before 
describing  those  parts,  I  shall  point  out  the  method  of  dis- 
secting the  vessels  of  the  abdomen,  and  the  manner  of  show- 
ing the  minute  anatomy  of  the  several  viscera. 

The  arteries  which  supply  the  viscera  are  very  easily  ar- 
ranged ;  indeed,  the  whole  anatomy  of  them  is  BO  simple, 
that  it  is  almost  a  pity  to  sacrifice  the  abdomen  for  the  arte- 
ries only;  we  should  therefore  endeavour,  at  the  same  time* 
to  make  a  dissection  of  the  venous  system. 

The  method  of  injecting  the  vessels  will  depend  upon  th/- 
manner  in  which  the  thorax  is  to  be  dissected. 

If  the  subject  be  young,  and  if  it  be  intended  to  make  u 
preparation  of  the  arteries,  then  those  of  the  abdomen  aro 
to  be  filled,  in  common  with  the  others,  from  the  arch  of  the 
aorta  ;  but>  in  the  usual  dissection,  where  the  parts  are  not 
to  be  preserved,  the  arteries  may  be  injected  after  the  mus- 
cles of  the.  abdomen  have  been  dissected.  To  do  this  neatly, 
we  should  tie  the  aorta  above  the  diaphragm,  and  also  one  bi 
the  iliac  arteries  at  its  origin  from  the  aorta,  and  then  put  a 
pipe  into  the  other  common  iliac,  as  close  to  the  aorta  as 
possible,  so  that  there  may  be  enough  of  the  artery  left  to 
enable  us  to  put  a  tube  into  it  afterwards  for  the  injection  of 
the  lower  extremity. 

When  we  inject  the  viscera  of  an  adult  subject  at  the 
same  time  with  the  vessels  of  the  upper  part  of  the  body, 
from  the  arch  of  the  aorta,  it  can  hardly  be  expected  that 
the  vessels  of  the  viscera,  or  of  the  limbs,  will  be  fully  dis- 
tended, for  the  size  and  dilatability  of  the  vessels  of  the  ab- 
domen will  take  off  the  force  of  the  syringe  from  the  smaller 
vessels. 

The  objection  to  introducing  the  pipe  into  the  aorta,  above 
the  diaphragm,  and  injecting  downwards,  is,  that,  to  manage 
the  pipe  properly,  a  great  part  of  the  thorax  must  be  destroyed. 

The  best  composition  for  the  injection  of  the  vessels  of 
the  viscera,  is  a  strong  solution  of  glue,  coloured  with  red 
lead,  or  an  injection  made  of  tallow  and  turpentine  varnish. 
As  both  of  these  compositions  must  be  used  while  warm,  it 
is  necessary  to  heat  the  vessels  of  the  abdomen;  this  is  most 
easily  done  by  making  an  opening  into  the  intestines,  and 
injecting  a  quantity  of  hot  water  into  them. 

The  veins  must  be  injected- before  the  intestines  are  exa- 
mined; and  as  there  are  no  valves  in  them,  the  injection  will 
be  easily  made. 

The  veins  of  the  liver  may  be  injected  from  the  ramifica- 
tions of  those  in  the  mesentery ;  or  the  veins  of  the  intestines 
may  be  injected  from  the  trunk  of  the  vena  portae.     To  find 
th?  vena  porta*  as  it  enters  the  liver,  the  stomach  should  br 
E 


50 

held  down,  and  the  smaller  omcntum  cleared  away  fr om  b«> 
twixt  the  stomach  and  liver :  the  vein  is  then  found  (covered 
in  part  witli  cellular  substance)  running  obliquely  across  the 
spine,  and  parallel  to  the  biliary  duct.  If  we  be  uncertain 
of  its  situation,  the  substance  of  the  liver  may  be  pressed 
gently  with  the  hand,  or  the  blood  urged  alon<*  the  veins  of 
the  intestines,  and  then  the  vena  portoe  will  rise  from  the 
confusion,  as  a  large  dark  blue  vein. 

But  to  understand  the  course  of  the  veins  which  form  the 
vena  portae,  and  at  the  same  time  not  to  endanger  the  cutting 
of  them,  we  should  inject  them  by  putting  a  pipe  into  the 
ileo  colic  vein.  This  branch  is  easily  found,  as  it  has  its 
name  from  being  subservient  to  the  caput  coli  and  that  part 
of  the  intestinum  ileon  which  joins  the  colon  ;  it  is  only  ne- 
cessary, therefore,,  to  fold  back  the  small  intestines  from  the 
right  os  ilium,  and  to  expose  the  caput  coli,  and  to  follow  up 
the  veins  till  they  have  assumed  a  size  large  enough  to  ad- 
mit the  tube.  After  puncturing  the  vein,  and  fixing  the 
tube,  there  should  be  a  ligature  put  upon  the  part  of  the 
vessel  behind  the  tube,  that  the  injection  may  be  prevented 
from  coming  round  and  escaping.  Before  throwing  in  the 
injection,  the  veins  should  be  repeatedly  syringed  with  warm 
water.  The  injection  may  be  made  to  run  more  minutely 
into  the  vessels  of  the  intestines  by  pressing  gently  upon 
the  trunk  of  the  vena  portae. 

As  the  venos  cavae  hepatic®  may  be  filled  by  a  successful 
injection,  the  vena  cava  should  be  tied  just  above  the  dia- 
phragm. The  vena  cava  itself  should  not  be  injected,  for 
its  branches  can  be  easily  traced  without  their  being  filled. 
When  they  are  injected  at  the  same  time  with  the  other 
vessels  of  the  abdomen,  they  encumber  the  dissector  very 
much ;  if  we  wish  to  fill  them,  we  should  put  a  pipe  into  the 
i'liac  or  femoral  vein. 

When  all  the  vessels  are  injected,  the  small  intestines 
should  be  removed,  and  the  colon  blown  up  according  to  the 
description  already  given  in  the  first  dissection  of  the  ab- 
domen. All  those  arteries  which  are  seen  on  the  part  of  the 
mesentery  which  has  been  left,  and  also-  on  the  right  side 
and  middle  of  the  mesocolon,  are  branches  of  the  superior 
mesenteric  artery ;  while  those  which  run  towards  the 
sigmoid  flexure  and  rectum,  are  from  the  inferior  mesen- 
teric. 

The  dissection  is  to  be  begun  with  the  loose  mesentery, 
by  dissecting  off  the  peritoneal  coat  and  fat  from  the  ves- 
sels. These  arteries  in  the  mesentery  have  no  appropriated 
names,  but  compose  one  set  of  innumerable  branches,  form- 
ing-, before  they  reach  the  email  intestines,  frequent 


51 

moses  and  arches,  by  which  the  capacity  of  the  branches 
combined,  must  be  wonderfully  increased  in  proportion  to 
that  of  the  single  trunk  from  which  they  arise. 

From  the  UPPER  MESENTERIC  ARTERY,  upon  the  right  side, 
three  branches  are  given  off  to  the  colon. 

The  ARTERIA  ILIO-COLICA  ;  whose  ramifications  connect 
the  branches  which  go  to  the  small  intestines,  with  those 
which  go  to  the  colon.  It  runs  down  to  the  caput  coli,  and 
last  turns  of  the  ileon.  Its  branches  upon  the  small  intes- 
tine inosculate  with  those  branches  of  the  superior  mesenteric 
which  are  distributed  to  the  small  intestines  in  general;  ancL 
upon  the  great  intestine,  it  inosculates  with  the  second  colic 
branch  of  the  superior  mesenteric  artery,  viz. 

The  COLIC  A  DEXTRA;  which  will  be  found  running  from 
the  root  of  the  superior  mesenteric  artery  across  towards 
the  right  side  of  the  colon,  where  it  begins  to  rise  over  the 
kidney,  inosculating  freely  with  the  last  branch,  and  up- 
wards with 

The  COLICA  MEDIA. — This  branch  goes  directly  upward.-' 
from  the  trunk  of  the  upper  mesenteric  artery,  as  it  comes 
out  from  under  the  mesocolon.  After  running  a  little  way 
upon  the  mesocolon,  it  divides ;  and  one  of  the  division* 
going  towards  the  right  side,  makes  a  large  circle  upon  th- 
mesocolon,  and  forms  a  great  inosculation  with  the  right 
colic  artery ;  while  the  other  division,  going  towards  the  left 
.side,  makes  such  another  sweep,  and  joins  with  the  left 
colic,  which  is  a  branch  from  the  lower  mesenteric  artery. 
These  two  branches  of  the  median  colic  artery  give  off  nu- 
merous ramifications,  which  supply  a  great  extent  of  the 
middle  part  of  the  colon. 

The  INFERIOR  MESENTERIC. — The  branches  of  the  inferior 
mesenteric  artery  are  easily  found. — The  dissection  may  be 
backwards,  from  the  hsembrrhoidal  artery  lying  upon  the 
back  and  upper  part  of  the  rectum.  Proceeding  up  along 
the  gut,  numerous  branches  are  found  distributed  to  that 
part  of  the  colon  which  forms  the  sigmcid  flexure.  These 
are  derived  from  the  uppermost  brancli  of  the  lower  mesen- 
1  eric,  and  as  it  supplies  the  left  side  of  the  colon,  it  is  called 
the  COLICA  SINISTRA;  it  communicates  with  the  median  colic 
brancli  of  the  upper  mesenteric  artery,  and  completes  a 
great  circle  of  inosculations,  reaching  all  the  length  of  thu 
intestinal  canal.* 

*In  the  dissection  of  the  lower  mesenteric  artery,  its  root 
is  found  entangled  by  the  nerves  of  the  lower  mesenteric 
plexus,  which  is  formed  by  branches  from  the  sympathetic. 
widby  branches  from  the  superior  mesenteric  plexus,  and 


52 

OF   THE   ACCOMPANYING  VEINS  SEEN  JN  THIS  VIEW  OP  THF 

INTESTINES. — The  branches  of  the  veins  run  here  in  com- 
pany with  the  arteries,  however  different  they  may  be  in  the 
direction  of  their  trunks.  Therefore  the  names  and  distri- 
bution of  the  one  set  of  vessels  being  known,  the  other  must 
be  known  also :  for  all  vessels  ehould  be  named  from  the 
parts  to  which  they  are  distributed,  and  not  from  the  trunks 
from  which  they  are  sent  off;  their  distribution  being  con- 
stant, their  derivation  irregular. 

The  veins,  as  seen  in  this  view  of  the  parts,  preserve  n 
uniform  course;  their  varieties  consisting  only  in  the  direc- 
tion of  the  trunks  in  which  they  are  gathered  to  form  the 
vena  portee. 

Returning,  then,  upon  the  demonstration  of  the  arteries — 
The  hicmorrhoidal  vein,  rising  from  the  back  of  the  recturm 
rway  be  easily  found ;  the  vena  coUca  sinistra,  coming  fron  i. 
the  left  part  of  the  colon,  is  united  to  the  last;  the  vena  colica 
media,  the  vena  colica  dextra,  and  the  vena  ilio  colica^  being 
united,  return  the  blood  from  the  arch  of  the  colon ;  while 
one  great  branch,  which  is  promiscuously  divided  among  the 
small  intestines,  carries  back  their  blood  to  the  vena  port  as 
These  veins  will  be  further  traced  in  the  next  view  of  the 
intestines. 

The  dissection  of  the  cceliac  artery,  of  the  trunk  of  the  vena 
portae,  of  the  arteries  and  veins  of  the  stomach,  and  of  the 
corresponding  arteries  of  the  liver,  gall-ducts,  and  pancreas, 
may  now  be  made. 

Separate  the  arch  of  the  colon  from  the  stomach,  and  lay 
It  down  in  the  manner  described  in  the  first  dissection. 

There  is  now  much  difficult  dissection.  The  stomach 
will  be  seen  lying  under  the  projecting  liver;  the  spleen, 
towards  the  left  end  of  the  stomach ;  the  pancreas  will  be 
found  lying  directly  across  the  aorta,  reaching  from  the 
spleen  to  the  duodenum,  and  involved  in  the  root  of  the  me- 
jsocolon. 

The  cceliac  artery  supplies  all  the  parts  lying  in  the  upper 
division  of  the  belly,  above  the  mesocolon.  It  is  the  second 
artery  of  the  abdominal  aorta,  coming  off  at  the  point  where* 
the  great  artery  seems  to  be  extricating  itself  from  the  dia- 
phragm. It  rises  directly  from  the  aorta,  as  a  short  trunk, 
\vlrich  divides  quickly  into  branches. 

The  best  way  to  dissect  this  artery,  is,  to  distend  the 
stomach  slightly,  and  then  to  pull  it  down,  so  that  we  may 

threat  coslic  plexus.  The  lower  mesenteric  plexus,  surround- 
ing- the  trunk  of  the  artery,  sends  branches  out  along  the 
to  the  left  side  of  the  colon,  and  to  the  rectum. 


•ct  the  lesser  "omentum  from  betwixt  it  and  the  liver, 
The  artery  will  then  be  found,  dividing  at  once  into  many 
branches ;  and  as  they  depart  in  different  directions  from  on<  - 
point,  as  from  a  centre,  the  trunk  is  called  the  axis  arteriw 
cceliacce. 

The  ARTERIA  CORONARIA  VENTRICULI  Will  be  foWld  g011]g 

off  towards  the  left  side,  and  spreading  largely  over  the  up- 
per part  of  the  stomach.  If,  in  dissecting  it  where  it  goes 
off  from  the  trunk  of  the  cceliae,  it  is  found  to  be  larger  than 
the  Other  branches,  it  may  be  expected  to  send  a  branch  to 
the  liver,  and  we  should  then  be  more  cautious  in  dissecting 
in  that  direction ;  for  the  vessel  will  pass  to  the  right,  and 
then  upwards,  till  it  be  lost  in  the  fossa  ductus  venosi.  When, 
there  is  no  branch  sent  to  the  liver,  it  holds  its  course  to  the 
left  or  superior  orifice  of  the  stomach.  Here  it  divides  into 
two  brandies  :  one  of  which  encircles  the  cardiac  orifice, 
and  inosculates  with  the  gastro-epiploic  artery  above  the 
spleen ;  the  other  runs  along  the  lesser  arch  of  the  stomach, 
sends  a  branch  over  the  side  of  the  stomach,  and,  continuing 
its  course,  inosculates  with  the  pylorica,  or  coronaria  dextra.  \ 
In  tracing  these  branches  upon  the  lesser  curvature  of  the 
stomach,  we  shall  find  several  nerves  which  are  branches  of 
the  eighth  pair,  or  par  vagum. 

The  ARTERIA  SPLENIC  A  arises  from  the  trunk,  or  axis  of 
the  coeliac  artery.  It  passes  under  the  stomach,  and  along 
the  border  of  the  pancreas,  where  it  gives  off  the  pancreati- 
cae  parvaa.  Continuing  its  serpentine  course,  it  gives  the 
vasa  brevia  to  the  stomach,  and  small  branches  to  the  meso- 
colon.  When  it  reaches  the  spleen,  it  makes  a  curve  in  its 
bosom,  and  enters  it  in  several  branches.  It  ?ends  off  from 
its  branches  in  the  spleen,  a  considerable  branch  to  the 
stomach,  which,  inosculating  with  the  right  gastro-epiploic 
artery,  is  called  the  gastro-epiploica  sinistra. 

The  ARTERIA  HEPATIC  A  runs  in  a  direction  opposite  to  the 
splenic  artery,  towards  the  right  side.  .  After  having  run 
some  way  in  the  direction  of  the  trunk  of  the  vena  portae,  it 
divides,  nearly  at  the  same  place>  into  four  branches,  which 
spread  over  the  trunk  of  the  vena  portae.  The  first  branch 
.sent  off,  is  the  arteria  gastro-epiploica  dextra,  so  named  from 
its  chief  branch;  or  sometimes  called  the  duodeno-gastriea, 
from  that  branch  of  it  which  goes  to  the  duodenum.  This 
artery,  descending  under  the  pylorus  to  gain  the  great  cur- 
vature of  the  stomach,  with  its  accompanying  vein,  catches 
the  eye  while  the  viscera  are  yet  entire.  It  is  seen  beauti- 
fully distributed  to  the-stomach  and  omentum ;  and  reaching 
the  left  and  obtuse  end  of  the  stomach,  it  inosculates  largel}* 
-.vith  the  splenic  artery,  As  this  gastro-epiploic  artery  runs 


54 

across  the  under  side  of  the  duodenum,  it  gives  oft4  the  pan- 
creatico  duodenalis,  which  runs  down  the  intestine,  ant 
rfends  a  considerable  branch  along-  the  pancreas. 

The  hepatic  artery,  after  sending-  off  the  gastro-epiploica 
ilextra,  divides  into  the  right  and  left  hepatic  branches. 
Prom  the  left  hepatic,  the  coronaria  dextra  is  sent  off,  which, 
turning  backwards,  spreads  its  branches  upon  the  pyloric 
end  of  the  stomach,  inosculating  with  the  proper  coronary  of 
the  superior  orifice,  and  with  the  pyloric  arteries,  which  are 
numerous  and  important  twigs  from  the  surroundingjgreater 
arteries; — the  coronary  sometimes  comes  off  from  the  trunk 
of  the  hepatic  artery,  climbing  upon  the  vena  ports?,  enters 
the  liver,  ceid,,  separating  into  branches,  is  distributed  within 
the  liver,  to  the  whole  of  the  left  kfbe,  the  lobe  of  Spigelius, 
and  part  of  the  right  lobe.  The  right  hepatic  artery,  passing 
under  the  hepatic  duct  of  the  liver,  is  distributed  to  the  right 
lobe  of  the  liver,  and  gives  a  branch  which  is  called  the  cys- 
tica,  to  the  gall-bladder. 

In  dissecting  the  root  of  the  coeliac  artery,  and  part  of  the 
aorta,  betwixt  it  and  the  superior  mesenteric  artery,  we  see 
the  ccelic  plexus,  which  is  formed  by  branches  from  the  se- 
milunar  ganglions  of  the  sympathetic  nerves,  and  from  the 
eighth  pair,  which  is  principally  distributed  to  the  stomach. 
Prom  this  plexus  an  immense  number  of  smaller  nerves  arc* 
sent  out,  forming  lesser  plexuses,  along  the  mesentery,  and 
to  the  duodenum,  liver,  spleen,  &c. 

Of  the  VEN^A.  PORT.SE. — The  vena  portse  is  formed  by  the 
union  of  the  veins  from  the  intestinal  canal,  and  from  those 
*  of  the  spleen  and  pancreas.  Near  the  liver,  these  veins  are 
collected  from  three  great  branches,  corresponding  to  the 
cosliac,  upper  and  lower  mesenteric  arteries.  The  trunk  of 
the  vena  portae  lies  obliquely  across  the  spine,  upon  the  body, 
and  under  the  head  of  the  pancreas.  The  branch  answering 
to  the  cceliac,  is  the  splenic  vein.  It  forms  one  of  the  great 
divisions  of  the  vena  portse,  as  it  gathers  the  blood  from  the 
spleen,  stomach,  pancreas,  and  omentum;  it  passes  from  the 
left  towards  the  right  side. 

The  veins  coming  up  from  the  lower  part  of  the  belly,  cor- 
responding to  the  mesenteric  arteries,  are  the  mesenterica 
major,  and  the  mesenterica  minor.  All  the  veins  from  the 
mesentery,  and  from  one  half  of  the  colon,  meeting  together, 
form  the  first  of  these;  which,  from  its  size,  is  the  most  im- 
portant vein  of  the  intestines.  Its  branches  run  in  company 
with  the  extremities  of  the  superior  mesenteric  artery,  which 
pass  from  the  duodenum  along  tne  track  of  the  intestines. 
to  the  middle  of  the  colon.  This  vein  joins  the  trunk  of  the 
venaportee. 


55 

The  vena  mesenterica  minor  carries  back  the  blood  fron> 
the  left  side  of  the  colon,  and  from  the  rectum,  accompanying 
the  lower  mesenteric  artery  in  its  whole  course.  From  the 
branch  which  mounts  up  upon  the  back  of  the  rectum,  it  has 
been  called  the  hcemorrhoidea  interna.  This  vein  joins 
sometimes  with  the  splenica ;  more  commonly  with  the  me- 
senterica major.  As  the  great  mesenteric  trunk  goes  up 
under  the  duodenum,  it  receives  the  veins  of  the  pyloric 
orifice,  and  those  answering  to  the  pancreatico-duodenal  ar- 
tery. As  the  trunk  of  the  vena  portse  runs  across  the  spine 
towards  the  liver,  it  receives  the  veins  from  the  right  side  of 
the  duodenum,  and  lesser  arch  of  the  stomach,  answering  to 
the  lesser  coronary,  or  right  coronary  of  the  stomach ;  then 
mounting  obliquely  upwards  and  towards  the  right  side,  it 
enters  the  porta  of  the  liver,  and  dividing  into  two  great 
branches,  forms  the  great  binus  of  the  liver. 

As  the  vena  portse  approaches  the  liver,  it  runs  parallel 
with,  and  between  the  ducts  and  the  hepatic  artery. — They 
are  here  included  in  one  sheath  of  cellular  substance,  viz. 
the  capsule  of  Glisson.  The  vena  portse  may  be  considered 
as  a  vein  which  performs  the  office  of  an  artery  in  the  liver,* 
by  distributing  in  it  that  blood  which  it  collects  from  the  ar- 
teries of  the  intestines.  But  the  proper  veins  of  the  liver, 
the  venae  cavie-  hepaticse,  return  their  blood  directly  to  then 
heart.  These,  in  their  extremities,  are  distributed  much 
like  the  vena  portae ;  but  upon  dissecting  the  under  surface 
of  the  liver,  they  are  found  to  run  up  towards  the  attachment 
of  the  liver  to  the  diaphragm,  and  to  enter  into  the  inferior 
cava  near  the  heart. 

In  dissecting  these  veins,  there  is  much  cellular  substance 
to  be  cleared  away ;  and  it  is  not  easy,  if  the  injection  be  at 
all  brittle,  to  dissect  upon  their  thin  coats  without  cutting 
them,  or  breaking  the  injection. 

The  arteries  which  run  to  the  kidneys,  and  the  spermatic-, 
may  now  be  seen  by  lifting  up  the  mesocolon  ;  but  in  order 
to  show  them  more  distinctly,  the  chylopoetic  viscera  should 
be  removed,  and  then  we  shall  have  a  more  distinct  view  of 
the  trunk  of  the  aorta,  and  the  large  branches  going  off  from 
it.  In  order  to  remove  the  viscera,  we- should  first  cut 
through  the  cceliac  artery  at  the  part  where  it  is  dividing  into 
its  branches,  and  through  the  superior  and  inferior  mesenteric 
arteries  ;  leaving  small  portions  of  each,  by  which  we  may 
recognise  them.  The  oesophagus  is  then  to  be  divided ;  and 

*  I  found  it  in  the  camel  which  was  dissected  in  Windmill 
Street,  in  April,  1821,  to  be  as  distinctly  muscular  as  the 
oesophagus,. 


56 

uy  separating  the  liver  from  the  diaphragm,  the  whole  of  the 
viscera  above  the  mesocolon  may  be  removed.  In  lifting 
the  colon,  we  must  take  care  that  we  do  not  cut  through  the 
arteries  to  the  kidneys,  or  the  spermatic  vessels ;  indeed, 
t.hese  vessels  ought  to  be  fully  exposed  before  the  colon  is 
raised,  as  the  spermatic  arteries  will  be  much  endangered  if 
we  pull  the  caput  coli  and  sigmoid.  flexure  rudely  up.  A 
portion  of  the  rectum  should  be  left.  We  may  now  observe, 
that  the  aorta  passes  between  the  crura  of  the  diaphragm, 
entering  the  abdomen  rather  on  the  left  side  of  the  spine,  but, 
that  as  it  passes  down,  it  comes  more  to  the  middle,  the  vena 
cava  is  seen  to  be  distinctly  upon  the  right  side  of  the  spine, 
and  continuing  in  the  same  line  until  it  passes  through  the 
perforation  in  the  tendon  of  the  diaphragm. 

We  should  now  turn  our  attention  to  the  kidneys.— -We 
see  one  on  each  side  of  the  spine,  and  lying  on  the  last  ribs, 
the  right  being  rather  lower  than  the  left.  In  a  young  body, 
we  see  a  fatty  mass  lying  on  the  upper  part  of  the  kidney, — 
this  decreases  in  size  in  the  adult;  it  is  called  the  renal  cap- 
sule, or  glandult  atrabiliaris  besides  this,  there  is  generally 
a  quantity  of  fat  surrounding  the  kidney.  From  the  bosom 
and  lower  part  of  the  kidney/  we  see  the  ureter,  or  duct, 
passing  towards  the  pelvis ;  which,  with  the  arteries  run- 
ning from  the  aorta  to  the  kidneys,  may  be  easily  exposed, 
by  merely  removing  the  cellular  membrane.  The  only  thing 
which  tends  to  make  the  dissection  of  t)*e  vessels  difficult,  is 
the  number  of  nerves  which  encircle  the  several  branches. 

We  ought  not  to  dissect  too  closely  between  the  right  cms 
of  the  diaphragm  and  the  aorta,  for  here  is  the  thoracic 
duct,  which,  with  a  little  care,  may  be  preserved,  so  that  we 
may  either  inject  it,  or  fill  it  with  air  by  the  blow-pipe;  but 
though  a  large  vessel,  it  is  difficult  to  find  it,  on  account  of  its 
being  empty  and  its  coats  transparent.  It  is  sometimes  pos- 
sible to  fill  it,  by  throwing  air  or  mercury  into  the  substance 
of  one  of  the  lymphatic  glands  which  lie  by  the  side  of  the 
jumbar  vertebrae. 

The  arteries  seen  when  the  cellular  membrane,  &c.  is  re-- 
moved, will  be- — the  phrenic  arteries,  which  are  sometimes 
branches  of  the  eoslic;  the  trunk  of  the  coalic  :  the  superior 
mesenteric  artery ;  the  capsulares,  which  sometimes  come 
from  the  emulgents ;  the  renal  or  emulgents ;  the  right  sper- 
matic, from  the  aorta ;  the  left  spermetic,  often  from  the  left 
emulgent;  and,  lastly,  the  inferior  mesenteric, — all  these  are 
seen  coming  from  the  forepart  of  the  aorta :  but  besides 
these,  a  regular  set  of  vessels  pass  into  the  spaces  between 
the  vertebrae, — these  are  the  lumbar.  There  are  also  gene- 
xally  some,  small  irregular  branches  to  the  glands.  &c* 


57 

The  aorta,  passing  down  towards  the  pelvis,  divides  into 
two  great  branches — 

The  COMMON  ILIACS  ;  and  from  these,  all  the  arteries  of 
the  pelvis  are  given,  except  those  to  the  rectum  from  the 
inferior  mesenteric,  and  to  the  uterus,  in  the  female,  from 
the  spermatic. 

Before  examining-  the  arteries  farther,  we  may  observe 
how  the  vena  cava  is  formed.  The  veins  of  the  stomach  and 
intestines,  the  pancreas  and  the  spleen,  we  have  already 
traced  into  the  vena  portee.  We  see  the  great  vena  cava 
formed  principally  by  the  veins  from  the  lower  extremities  ; 
but  we  shall  find  that  the  veins  of  the  kidney  and  the  testicle 
also  run  into  it.  We  may  observe  that  the  left  emulgent 
vein,  as  it  crosses  over  the  aorta,  is  much  longer  than  the 
right ;  and  that  the  left  spermatic  vein  almost  always  joins 
the  left  emulgent,  whiln  the  right  passes  direct  into  the  vena 
cava.  The  cava  occasionally  receives  some  branches  from 
the  lumbar  veins ;  it  then  passes  up  towards  the  diaphragm, 
— sometimes  it  passes  through  a  hole  of  the  liver, — which 
must  be  recollected  in  removing  this  viscus;  but  it  is  more; 
Commonly  covered  by  a  portion  of  the  liver,  which  forms  an 
arch :  just  as  it  is  passing  through  the  diaphragm  it  receives 
t  he  venos  cavse  hepaticro,  and  the  phrenic  veins. 

TABLE  OF  THE  ARTERIES  WHICH  ARE   SENT 
OFF  FROM  THE  ABDOMINAL  AORTA, 

L  PIIRENICA  DEXTRA. 
II.  PHRENICA  SINISTRA. 

III.  CCELIACA. 

IV.  MESENTERICA  SUPERIOR, 
V.  MESENTERICA  INFERIOR. 

VI.  CAPSULARES. 

VII.  RENALIS  DEXTRA  ETRENALIS  SINISTRA. 
VIII.  SPERMATICA  DEXTRA    ET   SPERMATICA 

SINISTRA. 
IX.  SMALL  BRANCHES  WHICH   GO  TO    TIIK 

URETERS,  FAT,  &c. 
X.  LUMBALES. 

T.  &  II.  PIIRENICA  DEXTRA  &  PHRENICA  SINIS- 
TRA, give  branches  to  the  Diaphragm,  inosculating 
with  the  Mammariss  Interme,  and  also  irregultu 


58 

branches  to  the  Pancreas,  to  the  Membranes  of  the 
Liver,  and  to  the  Spleen. 

III.  C  (ELI  AC  A,  from  which  come,  1.  CORONARIA  VENTRI- 

CULI  SUPERIOR  ;  2.  HEPATICA;  3.  SPLENICA. 

From  the  CORONARIA  VENTRICULI  SUPERIOR  there 
come  two  sets  of  branches,  viz.  a  superior  division  to 
the  stomach,  to  the  (Esophagus,  to  the  Diaphragm 
and  Omentum  Minus ;  and  the  inferior  division,  to  the 
Lesser  Curvature  of  the  Stomach,  and  the  Pylorica 
Superior. 

From  the  HEPATICA. — 1st.  The  Hepatica  Dextra. 
which  gives  off  the  Cystica — 2d.  Hepatica  Sinistnt. 
Sometimes,  3d.  Coronaria  Dextra — 4th.  Duodenu 
Gastrica.  The  lesser  branches  which  corne  frdm 
these  are  called  Pylorica  Inferior — Pancreafica  Duo- 
denalis — Gestro  Epiploica  Dextra — JPancreaticcc  and 
Epiploicce. 

From  the  SPLENICA. — Pancreaticce — 'Castro  Epi- 
ploica  Sinistra — and  Vasa  Brevia. 

IV.  MESENTERICA  SUPERIOR.— Distributed  to  UK; 

whole  of  the  Small  Intestines  ;  and  gives  oft' to  the 
Great  Intestines,  ILIO  COLICA — COUCA  DEXTRA — 
COLICA  MEDIA. 

V.  MESENTERICA  INFERIOR  has,  as  branches,  CO- 

LICA SINISTRA — HJKMORRHOIDALIS  INTERNA. 

VI.  CAPSULARES — These,  though  called  here  primary 

branches,  are  very  irregular,  coming  generally  from 
the  Renal,  and  even  sometimes  from  the  Phrenic. 

\7II.     RENALIS  DEXTRA  ET  RENALIS  SINISTRA. 

to  the  Kidneys. 

VIII.  SPERMATIC  A,  to  the  testicles  in  man— to  the  ova* 
ria  in  the  female. 

IX.  IRREGULAR  BRANCHES,  to  the  Ureters,  &c* 

X.  LUMBALES— Five  on  each  side. 

XI.  ILIAC^E  COMMUNES,    divided  into  the    ILIAC* 

EXTERNJE,  and  ILIACJE  LNTERNJE. 

XII.  SACRA  MEDIA. 

The  table  of  the  arteries  of  the  pelvis  will  be  given  after 
the  description  of  the  dissection  of  the  parts  in  the  pelvis. 

The  nerves  of  the  abdomen,  though  difficult  to  dissect, 
*»rc  eas^y  arranged,  for  they  some  principally  from  Uvv 


£?eat  sources,  the  par  vagum  and  the  sympathetic.  But,  as 
it  is  not  possible  to  form  an  accurate  idea  of  them,  without,  at 
the  same  time,  having  those  of  the  thorax  dissected,  I  shall 
defer  the  description  of  the  manner  of  dissecting  them,  until 
we  come  to  the  examination  of  the  thorax. 

MANNER  OF  EXAMINING 
THE  MINUTE  STRUCTURE  OF  THE  VISCERA, 

The  minute  structure  of  the  viscera  ought  to  he  more  at- 
tended to  than  it  generally  is  in  the  dissecting  room  ;  but  a*? 
I  cannot  enter  fully  into  the  description  of  it  here,  I  shall 
only  point  out  the  manner  of  proceeding. 

After  the  liver,  stomach,  duodenum,  spleen,  and  pancreas 
have  been  removed,  in  connection  with  each  other,  from  the 
body,  certain  parts  will  be  seen  more  distinctly  than  when 
they  were  in  situ.  The  examination  of  them  will  be  facilita- 
ted if  wre  distend  the  stomach  with  air,  for  then  the  entry  of 
the  oesophagus  into  the  cardiac  orifice  of  the  stomach,  the 
great  curvature,  the  lesser  curvature,  and  the  attachment  of 
the  spleen  to  the  stomach,  through  the  medium  of  the  vasa 
brevia  and  membranes,  will  be  easily  understood.  The  dis- 
sector will,  of  course,  a_gain  examine  the  several  vessels 
and  ducts  of  the  liver  and  pancreas. 

The  greater  part  of  the  stomach  is  covered  by  the  perito- 
neum, which  is  called  its  peritoneal  coat.  By  stripping  off 
a  portion  of  this,  the  muscular  coat  will  be  seen,  the  princi- 
pal fibres  of  which  may  be  traced  from  oesophagus.  Before 
examining  the  internal  coat,  the  stomach  should  be  separa* 
ted  from  the  other  viscera,  by  cutting  through  the  duode- 
num, immediately  below  the  pylorus.  It  is  then  to  be  open- 
ed, or  inverted. 

The  internal,  villaus,  or  mucous  coat  varies  in  its  appear* 
ance  in  the  several  parts  of  the  stomach.  IS  ear  the  esoph- 
agus, it  resembles  fine  cuticle,  which,  in  some  cases,  may 
be  seen  to  terminate  in  a  distinct  line.  In  the  great  curva- 
ture, it  has  more  the  appearance  of  a  secreting  coat ;  and  in 
some  animal?,  there  is  a  distinct  glandular  apparatus  here. 
Towards  the  pyk-.rji?,  the  mucous  coat  assumes  the  charac- 
ter of  the  inner  membrane  of  the  intestines. 

We  may  now  sec  the  impropriety  of  calling  the  structure 
at  the  pylorus,  a  valve,  ibr  it  is  distinctly  a  sphincter  muscle, 
which,  according  to  the  ancients,  was  as  a  porter,  that 
would  not  let  any  indigeetibie  matter  pass ; — from  this  idea  of 
its  use,  they  gave  it  the  name  of  pylorus. 

The  student  may  form  a  more  correct  idea  of  the  structure 
and  functions  of  the  different  parts  of  the  stomach,  by  exiu 


60 

mining  those  of  certain  animals,  particularly  of  the  horse,  or 
ass,  for  the  cuticular  lining  on  the  upper  part ; — of  other  do- 
mestic animals,  for  a  glandular  appearance  near  the  pylorus ; 
tind  of  the  sheep,  or  ox,  as  examples  of  the  complicated  struc- 
ture of  the  stomach  of  the  ruminating  animal,  which  forms 
a  contrast  with  the  stomach  of  those  of  the  carnivorous  kind, 
as  the  dog,  cat,  lion,  &c.  The  stomach  of  birds  is  also 
worthy  of  examination,  as  there  is  not  only  much  difference 
in  its  structure  from  that  of  an  animal  of  the  class  of  the 
mammalia,  but  there  is  also  much  variety  in  the  stomachs  of 
the  different  classes  of  birds,  as  of  those  which  live  upon 
grain,  and  those  which  are  carnivorous. 

The  opening  by  which  the  ducts  enter  into  the  duodenum, 
is  to  be  particularly  attended  to ;  when  the  gut  is  laid  open, 
or  inverted,  it  may  be  seen  ;  but  as  the  duct  opens  obliquely 
into  the  intestine,  we  shall  be  generally  obliged  to  pass  a 
probe  from  the  ductus  communis  choledochus  into  the  gut,  to 
mark  the  point  at  which  it  enters.  A  few  muscular  fibres 
resembling  those  of  the  ureters  in  the  bladder,  may  be  dis- 
covered in  connection  with  the  opening. 

The  whole  of  the  intestinum  tenue  is  of  the  same  struc- 
ture, having  a  peritoneal,  muscular,  and  villous  coat ;  but  as 
the  jejunum  is  a  larger  and  thicker  gut  than  the  ileon,  the 
different  coats  will  be  more  distinctly  seen  in  it.  If  we  tear 
off  a  portion  of  the  peritoneal  coat,  in  the  direction  of  the 
length  of  the  gut,  we  shall  see  the  longitudinal  muscular 
fibres ;  if  we  take  it  off  in  the  circle,  the  circular  fibres  will 
be  shown.  The  muscular  coats  of  the  stomach  and  intes- 
tines will  be  more  distinctly  seen  after  the  part  has  been 
plunged  once  or  twice  into  boiling  water.  The  valvulre  con- 
niventes,  or  folds  of  the  mucous  or  villous  coat,  will  be  seen 
by  inverting  a  portion  of  the  intestine,  and  putting  it  into 
water;  if  we  distend  the  inverted  gut  with  air,  and  then 
squeeze  it,  we  shall  show  the  cellular  coats. 

The  minute  structure  of  the  intestines  is  more  distinctly 
shown  by  injecting  part  of  them  with  size  and  vermilion  ;  to 
do  this  nicely  we  should  cut  off  a  portion  of  intestine,  with 
its  mesentery,  and,  after  tying  the  txvo  ends  of  the  gut,  put 
a  pipe  into  that  vessel  which  appears  to  be  the  trunk  of  the 
branches  that  are  passing  to  the  intestine. 

Upon  the  injected  gut,  some  small  transparent  vessels 
may  be  seen,  running  in  a  longitudinal  direction ;  these  are 
the  lacteals ;  and  by  opening  one  with  a  lancet,  we  may 
distend  it  with  air,  or  mercury,  which  perhaps  will  pass  into 
the  glands  of  the  mesentery,  and  then  into  the  secondary- 
vessels  which  pass  to  the  thoracic  duct.  When  the  injected 
gut  is  opened,  the  villous  nature  of  the  internal  membrane 


61 

will  be  more  evident ;  perhaps  some  white  points  may  i>. 
seen  upon  the  surface ;  they  are  the  mouths  of  the  lacteal^ 
full  of  chyle ;  but  this  appearance  will  only  be  found  when 
the  process  of  absorption  lias  been  going  on  immediately 
previous  to  death.  The  best  illustration  of  the  lacteal  sys- 
tem is  made,  by  giving  an  animal  some  meal  and  milk  about 
an  hour  previous  to  killing  it,  and  by  putting  a  ligature  round 
a  part  of  the  intestines,  or  by  tying  the  thoracic  duct  imme- 
diately after  death.  The  lacteals  will  be  then  distinct!} 
seen,  filled  with  the  white  matter  which  is  called  chyle"; 
they  are  much  more  numerous  on  the  jejunum,  than  on  the 
ileon. 

The  colon  is  next  to  be  examined :  there  can  be  no  diffi- 
culty in  distinguishing  this  from  any  of  the  other  intestines  ; 
for  we  have  not  only  the  great  omentmn  attached  to  it,  but 
also  little  projections  of  peritoneum,  called  appendices  epi- 
ploicae,  or  ornentula  ;  but  the  longitudinal  and  circular  bands 
of  muscular  fibres,  are  the  most  distinguishing  mark;-. 
The  circular  bands  are  very  numerous,  but  there  are  only 
three  longitudinal  ones.  On  examining  the  gut  more  mi* 
iiutely,  we  shall  find  that  there  are  very  few  lacteals  upon 
it,  but  plenty  of  absorbents ;  and  on  the  inner  surface,  tha* 
there  are  few  valvulaa  conniventes. 

The  parts  at  the  union  between  the  ileon  and  colon  ar*> 
complicated;  when  the  gut  is  distended  we  see  them  mon- 
distinctly ;  the  whole  is  called  capitt  co/i,  upon  which  we  par- 
ticularize,— the  ceecum,  which  is  the  name  given  to  that  gut 
which,  in  horses,  is  nearly  a  yard  long,  but  in  the  human 
body,  it  is  only  about  two  inches  in  length,  and  is  not  ob- 
servable except  when  distended  with  air ;  tlie  processus  ver- 
miformis  will  be  easily  discovered,  from  its  resemblance  to  an 
earth  worm.  The  valve  between  the  colon  and  ileon  cannot 
be  well  understood  except  when  the  gut  is  dried ;  but  even  in 
the  fresh  state,  on  opening  the  caecum  in  water,  the  valve 
may  be  seen  to  be  formed  by  the  projection  of  part  of  fhr 
muscular  and  internal  coat  of  the  ileon  into  the  colon,  .so  a  s 
to  present  an  appearance  like  the  flood-gates  of  a  canal-. 

The  peculiarities  of  the  rectum  will  be  observed  in  tin- 
dissection  of  the  parts  contained  within  the  pelvis ;  at  pre  • 
sent,  I  shall  only  remark,  that  there  are  in  the  colon,  and 
particularly  in  the  rectum,  mucous  folicles,  which  have  been 
called  glandulee  solitariae,  to  distinguish  them  from  folicles 
which  are  found  in  sets  in  the  small  intestines,  which  have 
been  there  called  the  glandulee  aggregate : — these  openings 
are  more  distinctly  seen  in  the  rectum  of  the  hon»e  o?  ass, 
than  in  the  human  body, 

F 


62 

The  most  "important  parts  of  the  liver  have  already  In- 
seen ;  but  when  it  is  completely  separated  from  the  other 
viscera,  some  points  may  be  more  easily  understood.  If  the 
liver  has  been  taken  from  a  young  body,  then  the  substance 
of  the  round  ligament  will  not  be  firm,  nor  completely  closed 
in  the  centre,  but  so  open,  that  a  probe  may  be  pushed  into 
it;  this  is  in  consequence  of  the  umbilical  vein  which  degen- 
erates into  the  round  ligament,  not  having  yet  become  so 
firm  as  it  is  found  in  the  adult.  If  we  trace  the  round  or 
umbilical  ligament,  we  shall  find  it  become  connected  witli 
the  vena  ports?,  and  then  pass  to  the  upper  and  back  part  of  the 
liver;  but  it  does  not  retain  the  same  name  through  its  whole 
course ;  for  as,  in  the  foetus,  the  vessel  which  passed  from  the 
vena  portse,  though  really  a  continuation  of  the  umbilical 
vein,  was  called  the  ductus  venosus, — so  is  the  ligamentous 
matter,  in  the  adult,  above  the  transverse  fissure,  called  the 
remains  of  the  ductas  venosus ;  and  even  the  portions  of 
the  great  fissure  receive  names  corresponding  to  the  terms 
used  in  describing  the  two  portions  of  the  umbilical  vein 
which  lie  in  them. 

There  are  only  two  fissures  in  the  liver  which  should  be 
named  : — the  Umbilical,  which  divides  the  right  from  the 
left  lobe, — and  the  Transverse,  in  which  the  great  branches 
of  the  vena  portes  lodge.  But  anatomists  have  chosen  to 
call  the  sulcus,  in  which  the  gall  bladder  lies ;  the  fissure 
of  the  gall  bladder ;  and  the  depression  on  the  back  part  of 
the  liver,  for  the  passage  of  the  great  vein,  has  been  called 
the  fissure  of  the  vena  cava,  though  it  is  not  unusual  for  the 
eava  to  pass  through  the  substance  of  the  liver ; — even  the 
notch  corresponding  to  the  convexity  of  the  vertebra?,  is 
sometimes  called  a  fissure.  Besides  these  fissures  which 
are  generally  described,  there  are  frequently  irregular  de- 
pressions, as  if  the  lobes  had  been  cut  with  a  knife. 

There  are  generally  five  lobes  of  the  liver  described, 
but  the  two  great  lobes  and  the  lobulus  Spigelii  are  the 
only  important  ones ;  for,  the  lobulus  quadratus,  or  anony- 
mous, is  only  that  portion  of  the  liver  which  is  between  the 
gall  bladder  and  the  umbilical  fissure, — while  lobulus,  or 
processus  caudatus,  is  the  name  given  to  that  part  of  the 
right  lobe  which  projects  to  the  lobulus  Spigelii. 

On  the  surface  of  the  liver  there  are  a  great  many  lym- 
phatics, the  branches  of  which  can  be  injected  from  the 
trunks,  as  the  valves  may  be  broken  down  by  the  weight  of 
the  quicksilver.  The  greater  number  of  the  trunks  pass  to- 
wards the  porta,  so  that  they,  also,  as  well  as  the  principal 
vessels  and  nerves  of  the  liver,  are  contained  within  the 
capsule  of  Glissou, 


63 

The  substance  of  the  liver  was  called  by  the  ancients,  pa- 
renchyma ;  a  name  implying  little  more  than  a  confused 
mass ;  and  if  we  make  a  section  of  the  liver,  though  we 
shall  see  a  great  number  of  subdivisions  formed  by  the  mem- 
brane which  supports  the  various  sets  of  vessels,  still  they 
are  so  bound  together,  that  it  is  very  difficult  to  ascertain 
the  real  structure  of  the  gland.  The  small  round  bodies,  of 
which  the  substance  is  principally  composed,  have  been 
called  acini,  and  have  been  supposed  to  be  the  terminations 
of  the  very  minute  branches  of  the  vena  portse,  which  are 
called  perdcilli.  The  biliary  ducts,  which  have  been  descri- 
bed as  conveying  the  secretion  from  the  acini,  are,  at  their 
commencement,  called  pori  biliarii. 

The  examination  of  the  structure  of  the  spleen  will  be 
still  less  satisfactory,  for  we  cannot  even  discover  a  duct  in 
it.  When  the  substance  is  minutely  injected,  it  appears  to 
be  made  up  almost  entirely  of  vessels,  the  extremities  of 
which  appear  to  communicate  with  cells,  which  are  con- 
nected by  cellular  membrane  that  has  a  particular  stellated 
appearance  when  a  section  is  made.  The  use  of  this  part 
will  probably  remain  always  a  problem ;  but  when  we  look  to 
the  immense  size  of  the  vein  passing  from  the  spleen  to  the 
vena  porta?,  we  must  suspect  it  to  be  in  some  way  subservient 
to  the  liver. 

The  pancreas  has  much  resemblance,  in  its  structure,  to 
the  parotid;  and  if  we  inject  its  duct,  we  shall  find  it  dis- 
tributed in  the  substance  of  the  gland,  in  the  same  manner 
as  the  ducts  are  arranged  in  the  salivary  glands  about  the 
jaw. 

The  structure  of  the  kidney  is  more  easily  understood 
than  that  of  any  other  viscus.  The  parts  may  be  seen  in  the 
uninjected  kidney,  but  much  more  distinctly  in  one  which 
has  been  minutely  injected. 

Before  we  can  understand  the  structure  of  the  adult  kid- 
ney, it  is  necessary  to  know,  that  in  the  foetal  state,  it  is 
composed  of  a  number  of  lobes,  which  give  it,  at  that  age, 
y,  lobulated  form ;  but  to  see  the  several  lobes  in  the  adult 
kidney,  we  must  make  a  section  of  it.  Each  lobe  may  be 
considered  to  be  almost  independent  of  the  others  ;  for  a 
separate  branch  of  the  renal  artery  passes  to  each,  and  has 
so  little  communication  with  those  of  the  other  lobes,  that 
we  may  inject  each  of  them  with  a  different  coloured  fluid. 

The  cortical  part  of  the  kidney  appears  to  be  that  in 
which  the  secretion  of  urine  is  effected.  It  is  highly  vascu- 
lar, and  when  minutely  injected,  small  round  bodies,  which 
are  called  corpora  globosa,  or  crypto,  are  seen  in  it ;  these 
haver  by  some  anatomists,  been  described  as  small  glands, — 


64 

by  others,  as  the  termination  of  the  convoluted  artery- 
Prom  these  bodies  we  may  discover  small  lines  passing  to? 
wards  each  of  the  white  papillae  in  the  centre  :  these  lines- 
are  said  to  be  the  tubuli  uriniferi,  terminating  in  the  ducts 
that  are  called  the  ducti  Bellini,  and  which  carry  the  urine 
that  is  secreted  in  the  cortical  part  to  the  papillae.  Upon 
each  papilla  a  depression  may  be  seen,  ana  if  we  squeeze 
the  part  of  the  kidney  corresponding  to  it,  a  little  urine  will 
drop  from  it.  The  pelvis,  is  the  name  given  to  the  membrane 
forming  the  upper  part  of  the  duct,  or  ureter ;  the  portions 
of  thii  which  pass  up  on  each  papilla,  are  called  either  calices 
or  inilindibula,  according  to  the  manner  in  which  they  aro. 
examined;  thus,  if  we  look  to  them  as  running  upwards, 
pad!  part  will  resemble  the  calyx  of  a  flower, — but  if  we 
fake  them  in  another  view,  they  will  appear  as  little  fun-: 
uels. 

The  structure  of  the  kidney  differs  much  in  certain  classes 
of  animals,  from  that  of  the  human  body.  In  the  kidney  of 
the  sheep,  there  is  a  very  close  resemblance  to  that  of  man  ; 
bat  in  the  lion,  dog,  cat,  &c.  the  kidney  is  never  tabulated, 
but  has  only  one  papilla, — whence  it  is  called  a  single  kid- 
ney. In  the  ox  it  continues  tabulated  through  the  whole  life 
of  the  animal :  but  the  best  examples  of  the  tabulated  kid- 
ney, are  those  of  animals  which  occasionally  inhabit  tha 
water,  as  the  bear,  seal,  &c. 

The  capsula  renalis,  or,  as  it  has  been  called  by  the  an- 
cients, glandula  atrabilaris,  is  of  very  curious  structure,  re- 
sembling a  piece  of  fat :  in  the  foetus,  it  is  large,  in  propor- 
tion to  the  kidney ;  but  in  old  age,  it  is  hardly  possible  to, 
discover  it; — the  only  thing  observable  in  it,  is  a  cavity,  iu 
which  there  is  occasionally  a  thick  blackish  fluid. 

I  trust  that  this  short  sketch  of  the  manner  of  investigat- 
ing the  minute  structure  of  the  viscera,  will  be  considered  as 
only  an  endeavour  to  induce  the  student  to  prosecute  this 
subject,  which,  though  difficult,  is  highly  interesting  and 
important. 

SOME  OBSERVATIONS  ON  THE  MANNER  OF 

EXAMINING  A  BODY  TO  DISCOVER  THE 

SEAT  OF 'DISEASE.. 

When  called  upon  to  make  a  private  examination  of  the 
state  of  the  abdomen  of  a  person  who  has  died  inconse- 
quence of  visceral  disease,  we  should  endeavour,  in  open- 
ing the  body,  to  disfigure  it  as  little  as  possible,  The  best- 


65 

•manner  of  proceeding  is,  to  cut  through  the  skin  only,  in  the 
line  of  the  linea  alba,  beginning  a  little  above  the  middle  of 
the  sternum,  down  to  the  pubes.  The  skin  may  be 
quickly  dissected  from  the  muscles,  and  pulled  over  to- 
wards each  side :  the  muscles  may  then  be  cut  in  any  direc- 
tion. 

If  the  body  is  not  very  fat,  this  longitudinal  cut  in  the 
skin  will  give  us  sufficient  room  for  our  examination  ;  but 
we  may  be  obliged  to  make  a  transverse  incision  below  the 
umbilicus.  When  the  dissection  is  finished,  and  the  skin  is 
sewed  up,  the  incision  should  be  concealed  by  strips  of 
strongly  adhesive  plaster. 

The  morbid  anatomy  of  the  viscera  is  a  subject  so  exten- 
sive, that  it  is  not  possible  for  me  to  enter  into  it  fully  here. 
All  that  the  limits  of  this  work  will  permit,  is,  to  endeavour 
to  point  out  a  few  of  the  circumstances  which  are  liable  to 
lead  those  who  are  not  conversant  with  anatomy,  to  make 
erroneous  statements  of  the  appearances  which  they  see  in 
making  the  examination  of  a  body. 

It  is  not  unusual  to  see  a  minute  description  given  of— 
•:  a  very  curious  displacement  of  the  viscera  ;"  but  the  posi- 
tion of  the  viscera  in  the  dead  body  depends  on  such  a  varie- 
ty of  circumstances,  that  we  ought  not  to  attach  importance  • 
to  any  trifling  change  from  that  which  is  considered  natural. 

The  bmentum  is  frequently  described  as  extra  sedem  :  but, 
if  I  were  to  take  the  description  of  the  omentum  from  the 
common  appearance  which  it  has  in  bodies  after  they  have 
been  moved,  I  should,  have  great  difficulty  in  saying  what  its 
natural  situation  really  is.  I  have  observed,  that  if  there 
has  been  any  inflammation  in  any  one  of  the  viscera,  at  any 
period,  that  the  omentum  is  found  attached  to  it :  thus,  the 
most  common  appearance  of  disease  in  the  abdomen  of  the 
female,  is  adhesion  of  the  omentum  to  the  uterus. 

It  is  a  very  common  mistake  to  describe  the  loaded  state 
of  the  vessels  as  an  appearance  denoting  previous  inflamma- 
tion :  the  state  of  the  true  inflamed  intestine  is  so  distinct, 
that  it  can  hardly  be  forgotten  after  it  has  been  once  sees, 
In  the  first  stage,  there  are  numerous  small  vessels  segn 
upon  the  gut,  Tike  those  on  the  eye  in  ophthalmia,  with  a 
suffusion  around  them ;  in  the  second  stage,  there  is  matter, 
or  lymph,  effused ;  and  in  the  more  advanced  state,  adhe- 
sions are  formed  between  the  surfaces  of  the  intestines.  But 
there  are  many  different  lands  of  peritonitis.  In  that  which 
is  called  idiopathic,  the  peritoneum  will  be  found  coated  with 
lymph ;  but  after  inflammation  in  consequence  of  strangulated 
hernia,  the  substance  of  the  intestine  will  appear  more  affect- 
ed than  the  proper  peritoneum.  I  cannot  enter  farther  on 


66 

this  important  subject;  but  shall  refer  to  a  very  early  work, 
by  Mr.  Bell,  in  which  much  interesting  matter  on  the  mor- 
bid anatomy  of  all  the  viscera  will  be  found. 

We  must  not  fall  into  the  mistake  of  supposing-,  that  the 
air  which  rushes  out  when  the  abdomen  is  opened,  has  been 
formed  during-  the  life  of  the  patient ;  for  though  there  may 
be  cases  of  true  tympanitis,  still  the  most  probable  cause  of 
the  formation  of  this  air,  is  the  change  produced  after  death 
by  putrefaction.  In  some  cases  of  gangrene  of  the  intes- 
tines, air  may  have  escaped  .into  the  general  cavity  immedi- 
ately before  death.  The  great  distention  of  the  stomach 
and  intestines,  is  also  commonly  produced  by  the  change 
which  takes  place  in  their  contents  after  death;  though 
there  is  always  more  or  less  air  within  the  intestines  during 
life. 

From  the  variety  of  appearances  of  inflammation, — from 
the  black  spots, — and  from  the  ulceration  and  corrosion, 
which,  in  the  course  of  my  dissections,  I  have  seen  in  the 
stomachs  of  those  who  have  died  without  any  marked  symp^ 
toms  of  affection  of  that  viscus, — and  from  the  close  resem- 
blance which  many  of  these  have  had  to  the  stomachs  of 
those  persons  who  have  swallowed  poison, — and  from  the 
similarity  of  the  appearances  produced  by  gastritis,  and 
other  diseases,  to  those  caused  by  poison, — I  have  come  to 
the  conviction,  that  the  appearance  of  the  stomach  or  int^s- 
. tines  alone,  in  a  question  of  poison,  is  not  to  be  depended  on* 
In  the  last  book  that  has  been  written  on  poisons,  (that  of  Or- 
filia,)  the  list  of  appearances  which  is  given,  as  to  be  expect- 
ed, where  poison  has  been  taken,  corresponds  exactly  with 
those  which  I  have  found  in  stomachs  where  I  was  certain 
no  deleterious  matter  had  been  taken.  I  am  happy  to  think, 
that  this  degree  of  uncertainty  will  prevent  the  anatomist 
from  being  called  On  to  decide  a  question  which  may  involve 
the  life  of  a  fellow  creature. 

In  examining  the  abdomen  of  children  wrho  have  died  in 
consequence  of  irritation  in  the  bowels,  we  shall  frequently 
find  one  portion  of  the  gut  invaginated  in  the  other.  This 
is  introsusceptio  ;  but  in  the  child  it  is  seldom  the  cause  of 
death,  while  in  the  adult  it  is  generally  attended  with  such 
inflammation  as  to  produce  strangulation  and  death.  If  a . 
patient  has  died  with  symptoms  of  hernia,  and  no  external 
tumour  be  discovered,  we  may  expect  to  find  an  introsus- 
ceptio, or  a  portion  of  the  intestine  strangulated,  by  a  noose 
formed  of  cojidensed  omentum,  or  mesentery  ;  in  these  ca- 
ses, the  portion  of  gut  above  the  point  of  strangulation  will 
be  red,  thickened,  and  distended,  while  the  portion 
*-vi'j  be  nale  and  emptv. 


67 

If  a  patient  has  long  suffered  from  chronic  inflammation 
of  the  abdomen,  we  may  expect  to  find  the  intestines  com- 
pletely glued  together  :  this  is  a  common  appearance  in  the 
abdomen  of  those  who  have  been  repeatedly  tapped.  In  the 
scrophulous  child  we  shall  probably  find  the  mesenteric 
glands  enlarged  and  cheesy ;  in  such  a  case,  the  lacteals 
will  be  often  found  filled  with  scrophulous  matter. 

In  the  greater  number  of  those  who  die  of  fever,  the 
mtestines  appear  gorged  with  blood — not  inflamed ;  but  on 
opening  the  lower  part  of  the  small  mtestines,  we  shall  ge- 
nerally discover  small  ulcers,  with  thickened  edges  :  this 
appearance  is  almost  always  found  in  the  great  intestines  of 
those  who  have  died  of  dysentery.  I  may  here  remark,  that 
a  small  pouch  occasionally  projects  from  the  side  of  the 
ileon ;  but  this  is  considered  only  a  lusus, — it  is  called  diver- 
ticulum  ilii. 

The  most  common  appearance  of  disease  in  the  liver,  is 
the  tubercle ;  and  this  occasionally  suppurates.  When  we 
look  to  the  proximity  of  the  colon  to  the  liver,  and  know, 
that  in  the  previous  inflammation  they  generally  adhere, — • 
we  cannot  be  surprised,  that  an  abscess  of  the  liver  should 
occasionally  communicate  with  the  colon,  and  the  matter  be 
discharged  by  the  rectum. — If  there  be  gall  stones  in  the 
gall  bladder,  or  ducts,  we  must  not  be  surprised  to  find  the 
coats  thickened,  for  this  is  a  natural  consequence  of  the 
irritation.. 

It  is  hardly  possible  to  say,  whether  the  softening  of  the 
spleen  is  to  be  considered  as  a  mark  of  disease,  for  it  is  ge- 
nerally softened,  in  all  old  subjects.  The  peritoneal  coat  is 
very  frequently  thickened,  and  particularly  in  those  who 
have  suffered  from  intermittent  fever,  as  the  Walcheren. 

The  pancreas  is  naturally  very  firm, — whence  it  is  not 
imfrequently  described,  by  those  not  familiar  with  anatomy, 
as  scirrhous ;  but  I  suspect,  that,  like  the  other  salivary 
glands,  it  is  very  seldom  diseased.  A  softening  and  tabula- 
ted form  of  the  kidney,  is  the  first  appearance  of  disease  in- 
this  viscus.  The  kidney  may  be  the  seat  of  primary  dis- 
ease, as  of  schrophula  or  stone^but  we  should  always  expect 
to  find  it  more  or  less  altered  in  structure,  when  there  has 
been  disease  or  irritation  in.  the  bladder.  We  should  not 
forget,  that  there  is  occasioimlly  a  yery  curious  variety  in  the 
natural  form  of  the  kidney,  for,  sometimes,  the  two  kidneys 
are  united  with  each  other,  sa  as  to  present  the  form  of  a 
crescent, — whence  this  lusus  is  called  the  horse  shoe  kidney. 
In  such  cases,  I  have  sometimes  found  three  ureters,  but  ge- 
nerally only  one.  It  is  not  unusual  to  find  two  ureters  corne 
from  one  of  the  kidneys,  whichj  in  other  respects,  is  of  the: 
common  form, 


68 

DISSECTION 

OF  THE 

PARTS  IN  THE  PERINEUM. 


AFTER  the  student  has  finished  the  dissection  of  the  mus- 
cles and  of  the  viscera  of  the  abdomen,  he  should,  in  union 
with  his  companion,  dissect  the  parts  in  the  perineum ;  but 
if  the  body  be  that  of  a  female,  he  had  better  proceed  to 
the  dissection  of  the  muscles  of  the  thigh.  It  is  almost  need- 
less to  remark,  that  before  the  muscles  of  the  perineum  can 
be  shown,  that  the  students  who  are  dissecting  the  upper 
half,  and  to  whom  all  the  muscle's  of  the  back  belong,  must 
either  permit  the  body  to  be  cut  through  at  the  loins,  or  to 
be  put  into  a  certain  position.  Although  some  of  the  mus- 
cles of  the  back  must  be  cut  in  dividing  the  body,  still  it 
•will  be  to  the  advantage  of  all  parties  that  the  division  should 
be  made,  for  the  four  dissectors  must  now  necessarily  in- 
terfere very  much  with  each  Qther. 

When  we  consider  the  operations  which  we  may  be  called 
upon  to  perform  on  the  parts  in  the  perineum,  we  shall  have 
a  just  notion  of  the  necessity  of  the  study  of  the  anatomy  of 
this  part,  to  the  surgeon  who  proposes  to  be  an  operator. 
But  when  it  is  known,  that  a  common  abscess  in  the  peri- 
neum has  not  unfrequently  been  the  cause  of  death,  in  con- 
sequence of  the  peculiar  formation  of  these  parts,  it  will  be 
allowed,  that  the  study  of  the  minute  anatomy  of  the  peri- 
neum, should  not  be  confined  to  the  operating  surgeon  only. 
No  one  will  assert  that  he  can  safely  manage  even  the  slight- 
est obstruction  in  the  urethra,  unless  he  knows  every  turn  of 
the  passage :  and  if  he  cannot  be  confident  in  his  treatment 
of  a  most  common  case,  how  can  he  possibly  understand  the 
proper  and  safe  treatment  of  those  complicated  fistulse  which 
are  now  so  frequent,  and  which  require  such  nice  opera- 
tions ?  It  might  be  thought  that  such  observations  were  quite 
unnecessary,  were  it  not  a  common  opinion  among  students, 
that  even  the  operation  of  lithotomy  may  be  performed,  by 
one  who  is  not  conversant  with  the  anatomy  of  the  parts,  if 
lie  makes  use  of  instruments  which  are  nicely  adapted  t« 
i  other- 


69 

Though  much  has  been  written  on  the  perineum,  and 
though  many  valuable  observations  have  been  made  on  par- 
ticular parts,  still  the  anatomy  of  it  is  so  complicated,  that  I 
have  found  very  few  students  who  were  capable  of  making 
themselves  masters  of  the  many  points  of  interest,  unless 
they  went  through  a  regular  series  of  dissections.  I  shall, 
therefore,  endeavour  to  describe  such  a  course  of  dissections 
of  the  perineum,  as  will  enable  the  student  to  comprehend 
the  simple  anatomy,  and  also  the  manner  of  examining  the 
parts,  so  as  to  discover  the  causes  of  difficulty  in  the  seve- 
ral operations. 

In  such  a  complicated  structure  as  the  outlet  of  the  pelvis, 
it  will  be  absolutely  necessary  to  dissect  the  parts  many 
times  :  I  shall,  therefore,  in  pointing  out  what  I  conceive  to 
be  the  best  plan  of  proceeding,  endeavour  to  describe  it, 
that  the  student  may  make  the  most  of  each  body  which  he 
dissects. 

I  shall  first  show  the  method  of  performing  the  dissection 
so  as  to  enable  the  student  to  acquire  a  general  idea  of  the 
muscles,  and  of  those  parts  which  are  connected  with,  tho 
passage  of  the  semen,  the  urine,  and  the  fceces. 

POSITION  OF  THE  BODY. 

Tie  the  hands  and  feet  so  as  to  put  the  body  in  the  same 
position  in  which  a  patient  is  placed  for  the  operation  of  lith- 
otomy ;  then  put  a  block  under  the  sacrum — introduce  a 
sound  into  the  bladder — tie  the  glans  penis  to  the  upper  part 
of  the  sound,  and  then  fix  it  in  the  centre,  by  tying  it  to 
both  knees. 

Before  commencing  the  dissection,  the  rectum  should  be 
desired  of  its  contents,  by  throwing  in  water  forcibly  with  a 
syringo ;  a  little  baked  hair  is  then  to  be  pushed  into  the 
rectum,  and  a  round  cork,  with  a  string  tttttichud  to  it,  should 
bo  passed  just  within  the  sphincter  :  this  will  be  found  useful 
in  bringing  the  sphincter  forwards. 

Place  a  pelvis  in  the  same  position  as  the  body,  and  com- 
pare the  ramus  of  the  pubes  and  ischium,  and  the  tuberosity 
of  the  ischium,  with  the  same  parts  in  the  subject ;  then 
make  the  first  incision  along  the  ramus  of  the  pubes  and 
ischium,  down  to  tho  tuberosity  of  the  ischium.  Make  a 
second  through  the  skin  only,  along  the  Raphe,  in  the  mid- 
dle of  the  pern's,  to  within  £  of  an  inch  of  the  anus  ;  and 
then  a  third,  from  the  one  on  the  tuberosity  of  the  ischium, 
to  the  termination  of  the  cut  on  the  Raphe.  Make  stilif 
another  incision  through  the  skin  round  the  anus,  beginning 
te  union  of  the  cross  and.  longitudinal  incisions;  and. 


70 

lastly,  feal  for  the  os  coccygis,  and  make  a  cut  from  it  to  the 
circular  one  around  the  anus. (a) 

These  incisions  will  enable  us  to  expose  the  principal  mus- 
i-les.  The  cut  along-  the  ramus  of  the  pubes  and  ischium, 
»vill  show  the  course  of  the  erector  penis  :  the  cross  cut, 
that  of  the  transversalis  ;  the  incision  along  the  Raphe  will 
show  the  union  of  the  two  ejaculators  ;  and  the  circular  cut 
will  be  in  the  line  of  the  fibres  of  the  sphincter  ani.  It  is 
better  to  make  these  incisions  on  both  sides  ;  for  I  have  al- 
ways found  that  the  student  got  a  very  imperfect  idea  of  the 
anatomy  of  the  perineum,  from  the  examination  of  one  side 
only. 

The  dissection  is  to  be  begun  by  cutting  on  the  line  of 
the  ramus  of  the  pubes  and  ischium,  so  as  to  expose  the  fibres 
of  the  erector,  which  will  be  found  to  form  a  tendinous  ex- 
pansion that  spreads  upon  the  crus  of  the  penis.  But  we 
must  be  particularly  careful  in  dissecting  the  origin  of  this 
muscle,  for  the  transversalis  is  connected  with  it.  The  same 
dissection  should  be  made  on  the  other  side,  and  then  there 
will  be  a  distinct  view  of  the  crura  of  the  penis,  and  the  at- 
tachment of  the  erectors. 

The  next  step  will  be,  to  dissect,  in  the  line  of  the  cross 
cut,  as  far  as  to  the  union  with  that  in  the  line  of  the  Raphe, 
with  the  intention  of  laying  bare  the  fibres  of  the  transver- 
salis. But  the  student  is  very  liable  to  be  foiled  in  his  first 
attempt  to  dissect  this  muscle,  because  its  fibres  are  not 
only  frequently  very  indistinct,  but  its  place  is  often  supplied 
l>y  a  set  of  fibres  from  the  levatur  ani.  Sometimes,  indeed, 
we  may  discover  two  transversales ;  while  in  other  bodies 
there  is  no  proper  transversalis,  but  a  set  of  fibres  which, 
though  they  may  have  the  same  origin,  take  a  direction  ob- 
liquely upwards.  This  slip  of  fibres  has  been  called  the 
transversalis  alter.  The  transversalis  is  considered  regular. 


figure  ;  the  two  obtuse  angles  of 
are  inward  from  the  tuberosities  of  the  iechia  :  consequently, 
it  has  an  anterior  acute  angle  at  the  arch  of  the  pubis  : 
the  posterior  acute  angle  being  in  the  situation  of  the  apex 
of  the  sacrum,  from  which  the  os  coccygis  is  seen  stand- 
ing forward,  this  bone  having  its  motion  within  the 
apace  of  the  outlet.  By  reason  of  the  more  depending 
situation  of  the  tuberosities  of  the  ischia,  the  boundarie^ 
of  the  outlet  are  not  on  a  plain  ;  but  are  to  be  considered 
collectively  as  forming  an  obtuse  angle  at  an  imaginary  line 
^tending-  from  one  tubcrosity  of  the  ischium  to  the  other. 


71 

when  it  is  inserted  with  the  other  muscles  into  the  condens- 
ed cellular  membrane  on  the  lower  part  of  the  bulb. 

The  ejaculator  seminis  may  now  be  shown  by  dissecting 
carefully  from  the  cut  in  the  Raphe,  towards  the  erector  pe- 
rn's and  cms  of  each  side.  After  the  fibres  of  this  muscle  are 
exposed,  the  loose  skin  should  be  taken  off  from  the  penis> 
so  that  a  more  distinct  view  of  the  parts  may  be  given. 

We  may  now  proceed  with  the  dissection  of  the  lower 
part,  by  cutting  in  the  line  of  the  incision  which  has  been 
made  round  the  verge  of  the  anus,  so  as  to  expose  the  fibres 
of  the  sphincter.  In  doing  this,  the  dissector  will  discover, 
that  the  most  superficial  set  of  fibres  is  attached  to  the  skin 
in  the  line  of  the  Raphe,  but  that  the  greater  mass  of  the 
muscle  is  inserted  into  that  point  at  which  the  two  transver- 
sales  and  ejaculators  unite ;  indeed,  this  point  is  often  called 
the  "  common  centre  of  union." 

When  the  dissection  of  the  sphincter  is  continued  up  for 
about  an  inch  upon  the  rectum,  some  of  the  fibres  of  the 
levatur  ani  will  be  seen ;  but,  to  expose  the  whole  of  this 
muscle,  it  will  be  necessary  to  remove  a  large  quantity  of  fat 
and  cellular  membrane  from  the  side  of  the  rectum.  This 
may  be  done  very  boldly,  if  we  keep  below  the  level  of  the 
trans versalis,  for  we  may,  without  fear,  set  our  knife  on  the 
edge  of  the  tuber  ischii,  and  carry  it  full  £  of  an  inch  in- 
wards and  downwards,  without  the  risk  of  cutting  any  fi- 
bres, except  some  of  the  gluteus  maximus. 

The  object  of  this  first  dissection  being  only  to  acquire  a 
general  knowledge  of  the  relative  situation  of  the  principal 
parts,  we  ought  not  at  present  to  attend  to  the  vessels,  but 
proceed  to  remove  the  superficial  muscles. 

It  will  not  be  necessary  to  remove  the  erectors,  for  the 
erura  penis  are  sufficiently  distinct  while  they  are  attached  to 
them ;  but  the  fibres  of  the  ejaculator  and  of  the  transversa- 
lis,  are  to  be  carefully  raised,  so  as  to  expose  the  spongy 
body  and  its  bulb.  After  removing  the  fibres  of  the  ejacula- 
tor, which  arise  from  between  the  erector  and  bulb,  the  fas/- 
cia,  or  ligament,  which  is  called  triangular,  will  be  seen  ;  or 
by  pushing  in  the  finger,  the  ligament  will  be  felt. 

After  studying  the  appearance  of  the  parts  now  presen- 
ted, a  dissection  of  the  pelvis  should  be  made,  so  as  to 
show  the  penis,  bladder,  &c.  in  their  mutual  relation  to 
each  other. 

The  penis  and  bladder  should  be  left  attached  to  the  right 
limb,  that  there  may  be  a  view  of  that  side  which  is  cut  in 
the  operation  of  lithotomy.  The  first  step,  in  making  the 
section,  is  to  cut  the  left  crus  of  the  corpus  cavernosum 
from  the  ramua  of  the  pubes  and  ischium,  and  through  tl;e 


72 

skin  of  the  pubes  and  muscles  of  the  abdomen;  taking  care 
to  avokl  the  spermatic  cord  and  testicle.  The  body  is  then 
to  be  untied  and  laid  upon  its  back,  the  staff  is  to  be  taken 
out  of  the  bladder,  and  the  hair  from  the  rectum.  The  hand 
is  to  be  introduced  into  the  pelvis  (it  is  presumed  that  the 
muscles  of  the  abdomen  are  already  dissected  ;  and  all  the 
viscera,  except  the  rectum  and  bladder  removed),  and  the 
rectum  and  bladder  are  to  be  pulled  over  towards  the  right 
side ;  taking  care  that  the  peritoneum  be  not  torn  from  them* 
nor  the  ureter  injured. 

The  division  of  the  bones  are  now  to  be  made,  by  cutting 
with  the  saw, — not  exactly  through  the  symphysis,  but 
father  to  the  left  of  it ;  but  in  doing  this,  we  must  take  care 
that  we  do  not  cut  the  origin  of  the  gracilis  muscle,  on  the 
inside  of  the  thigh. 

The  bone  having  been  sawed  through,  and  the  viscera  of 
the  pelvis  held  aside, — and  the  fibres  of  the  levator  arii  being 
carefully  cut,  the  knife  (without  regarding  the  pyriformis, 
great  nerve,  &c.)  is  to  be  carried  through  the  parts,  up  to 
the  notch  of  the  ilium  ;  and  then  the  thighs  being  forcibly 
pulled  asunder,  the  left  leg  will  be  separated  from  the  trunk, 
at  its  union  with  the  sacrum.  Tire  muscles  on  the  back  part 
are  then  to  be  cut,  and  the  left  limb  removed.  In  making 
this  section,  some  of  the  arteries  and  nerves,  with  certain 
muscles  of  the  left  side,  will  be  necessarily  destroyed  ;  but 
they  may  be  preserved  if  we  make  the  division  more  in  the 
middle  of  the  pelvis ;  to  do  this,  we  must  pull  the  viscera 
quite  over  to  the  right  side,  so  that  we  may  saw  through  the 
middle  of  the  sacrum  and  the  symphysis  of  the  pubes ;  but 
in  doing  it,  we  must  carefully  avoid  the  urethra.  By  pro- 
ceeding in  this  manner,  the  muscles  of  the  hip  will  be  saved, 
but  still  the  deep  muscles  of  the  back  must  be  cut  through 
by  a  cross  incision  ;  however,  these  muscles  are  of  little  im- 
portance, compared  to  the  parts  seen  in  the  lateral  view  of 
the  pelvis  :  indeed  the  body  should  be  divided  immediately 
above  the  sacrum,  before  the  perpendicular  section  is  made. 
This  last  method  may  be  sufficient  to  give  a  general  idea  of 
the  bladder,  rectum,  and  urethra ;  but  to  form  an  accurate 
notion  of  the  relation  of  these  viscera  to  each  other,  we 
must  make  the  section  according  to  the  manner  first  de- 
scribed. 

The  view  which  is  now  given,  will  seem  somewhat  confu- 
sed to  a  dissector,  in  his  first  essay;  for  he  will  not,  ae  yet, 
be  able  to  distinguish  the  bladder  or  rectum  :  but  to  make 
them  distinct,  it  is  only  necessary  to  distend  them.  By  in- 
troducing a,  blow-pipe  into  the  urethra,  the  bladder  may  be 
blown  up ;  but  if  the  staff  has  been  passed  into  the  urethra, 


73 

*h'  bladder  may  be  distended  by  blowing  into  one  of  the  uiv 
t  ers.  A  small  quantity  of  hair  is  again  to  he  put  into  the  rec- 
turn.  The  form  and  situation  of  the  bladder  will  now  1  < 
distinct ;  but  as  the  surface  will  still  he  obscured  by  the  pe- 
ritoneum which  covers  a  great  part  of  it,  it  may  be  useful, 
even  in  a  first  dissection,  to  pay  some  attention  to  the  fold* 
of  this  membrane. 

The  peritoneum  will  be  seen  passing  from  the  muscles  of 
the  abdomen  to  the  fundus  of  the  bladder,  and  from  that, 
continued  down  upon  the  back  and  lateral  parts.  It  then  ri- 
ses on  the  front  of  the  rectum,  so  as  to  form,  a  bag.  or  pouch. 
between  the  bladder  and  rectum  :  the  lateral  boundaries  of 
which  are  sometimes  called  the  posterior  ligaments  of  the 
bladder.  If  the  lower  part  of  the  muscles  of  the  abdomen  be 
still  entire,  we  may  see  the  remains  of  the  umbilical  arteries 
running  up  along  the-  lateral  parts  of  .the  bladder  to  the  um- 
bilicus,— and,  between  them,  the  urachus  passing  from  the 
fundus.  These  parts  will  appear  like  three  thickened  lines 
upon  the  peritoneum. 

The  peritoneum  may  now  be  raised  ;  it  is  so  loosely  con- 
nected with  the  bladder  at  the  fundus,  that,  with  the  fingers 
only,  wre  may  tear  it  from  the  muscular  coat  of  the  bladder ; 
but  we  must  remove  it  more  cautiously  from  the  lower  pait, 
or  we  may  destroy  the  ducts  of  the  testicle,  which  run  on 
each  side  of  the  bladder ;  but  these  ducts  are  so  thick  and 
dense,  that,  though  they  may  not  be  seen,  they  will  be  easilv 
felt.  If  we  put  small  bougies  into  the  ureters,  as  a  guard 
against  wounding  them,  we  may  proceed  more  boldly  in  re- 
nioving  the  peritoneum  from  the  lower  part. 

TLe  muscular  fibres  of  the  upper  part  of  the  bladder  will 
now  be  seen ;  but  a  great  deal  of  dissection  is  required  to 
make  the  parts  below,  distinct.  Part  of  the  rectum  is  still 
Covered  by  the  levator  ani,  whicji  ought  now  to  be  dissected 
away,  and  then  a  quantity  of  cellular  membrane  will  be  seen 
between  the  rectum  and  bladder.  In  removing  this,  the 
knife,  must  be  used  cautiously,  until  a  portion  of  the  vesicu- 
la  seminalis,  which  lies  between  the  rectum  and  bladder,  is 
exposed ; — it  will  be  known  by  its  dark  glistening  appearance. 

If  we  follow  the  vesicula  forwards,  we  shall  discover  the 
lateral  part  of  the  prostrate  gland.  The  bulb  should  now  be 
made  distinct  by  removing  any  muscular  fibres  that  may  be 
attached  to  it ;  but  we  must  be  very  careful  in  dissecting 
immediately  under  it,  for  the  little  bodies  which  are  called 
Cowpers  glands,  are  situated  here.  These  bodies  are  not 
very  easily  shown  ;  but  by  taking  the  bulb  between  the  fiu 
ger  and  thumb,  we  shall  readily  discover  them ;  although 
G 


74 

they  will  have  rather  the  feel  of  condensed  cellular  mem- 
brane than  of  glands. 

After  having  made  the  prostate  and  bulb  distinct,  the 
portion  of  the  urethra  which  is  between  them,  and  which  it- 
called  the  membranous  part,  is  to  be  examined.  The  staff 
may  be  felt  in  it ;  but  the  muscular  fibres  and  ligaments  which 
Furronnd  it,  give  it  a  very  different  appearance  to  what  we 
should  have  expected  to  find,  from  the  description  there  is  of 
it  in  the  greater  number  of  books  on  anatomy. 

Such  a  dissection  as  has  been  described,  will  enable  tho 
young  student  to  understand  the  principal  parts  connected 
with  the  passage  of  the  semen,  of  the  urine,  and  of  the  l»v 
ces ;  and  will  enable  him  to  follow  the  descriptions  which 
are  given  in  the  "  Systems  of  Anatomy." 

As  it  will  net  be  possible  in  this  view,  to  gain  more  than 
a  general  knowledge  of  the  parts  which  are  cut  in  lithotomy. 
I  shall  only  remark  at  present,  that,  in  this  operation,  after 
the  external  muscles  are  cut  through,  the  knife  is  introduced 
into  the  membranous  part  of  the  urethra,  and  is  carried  on, 
so  as  to  cut  the  lateral  part  of  the  prostate  ;  the  level  of  the 
incision  being  sufficiently  high  to  avoid  the  vesicula  semi- 
nalis. 

Although  the  parts  may  not  have  been  dissected  in  the 
manner  best  adapted  for  showing  the  causes  which  prevent 
the  introduction  of  the  catheter,  yet  it  maf  be  well  to  re- 
move the  staff,  and  again  to  introduce  it.  In»doing  this,  we 
cannot  avoid  observing,  how  liable  the  instrument  is  to  be 
caught  at  the  bulb,  and  the  danger  there  would  be  of  1orni- 
ing  a  false  passage,  if  we  force  it  on.  When  we  open  tlie 
urethra,  we  shall  find  that  there  is,  at  this  point,  a  natural 
pouch,  which  is  called  the  sinus  of  the  urethra. 

By  putting  the  hand  on  the  bladder,  and  pushing  it  towards 
the  rectum,  we  shall  see  the  attachments  which  it  has  to  the 
es  pubis,  and  which  are  called  its  anterior  ligaments.  Be- 
tween these  we  may  see  a  number  of  holes,  which  form  the 
faby-rinth  through  which  the  veins  of  the  penis  pass.  The 
rectum  should  now  betaken  away,  so  that  we  may  get  a  bet- 
ter view  of  the  vesiculse,  vasa  defer  en  tia,  and  ureters.  After 
these  parts  have  been  examined  in  their  relative  situation  to 
each  other,  the  bladder  and  penis  should  be  removed  from 
the  piibes.  To  do  this,  it  is  only  necessary  to  separate  the 
right  cms  of  the  penis  from  the  bone,  and  to  cut  through  the 
ligaments  of  the  bladder,  and  the  vasa  deferentia  and  ure- 
ters. The  bladder,  when  detached,  is  again  to  be  distend*- 
ed,  and  a  straight  staff  is  to  be  passed  into  the  urethra. 
The  cellular  membrane  may  then  be  removed  more  carefully 
from  the  tower  part  of  the  bladder,  so  thai  the  v-eekuta  semi*- 


75 

•  tales  and  vasa  deferentia  shall  be  still  more  distinctly  seen. 
To  show  the  lateral  lobes  of  the  prostrate,  it  will  be  only 
necessary  to  remove  the  cellular  membrane,  and  the  large 
veins  that  are  upon  it ;  but  if  we  follow  the  vasa  deferentia 
quite  into  the  prostate,  and  then  separate  them  from  each 
other,  we  shall  see  the  little  projection  of  the  gland  that  has 
been  called  the  middle  lobe,  and  which,  in  consequence  of  a 
mistake  made  in  the  description  of  the  morbid  anatomy  of 
the  prostate,  has,  of  late  years,  been  considered  of  much 
more  importance  than  it  deserves.  We  may  now  take  off 
the  muscular  fibres,  &c.  from  that  portion  of  the  urethra 
which  is  between  the  prostate  and  the  bulb,  so  as  to  give  it 
more  resemblance  to  a  membranous  part,  as  it  is  generally 
described  :  the  staff  being  still  in  the  urethra,  will  prevent 
us  from  cutting  it.  The  bulb  and  Cowper's  glands  should 
also  be  made  more  distinct. 

Before  examining  the  structure  of  the  cavernous  and 
spongy  bodies,  they  should  be  distended.  One  of  the  crura 
of  the  corpus  cavornosum  is  to  be  tied,  and  a  blow-pipe  fixed 
into  the  other.  Though  this  body  maybe  fully  distended,  the 
spongy  body  will  still  remain  flaccid,  for  there  is  no  direct 
communication  between  it  and  the  cavernous  body.  To  dis- 
r<-u:i  it.  it  will  be  necessary  to  make  a  puncture,  sufficient  to 
admit  a  blow-pipe  into  its  substance. 

A  bougie,  or  straight  staff,  being  still  in  the  canal,  the 
bladder,  prostate  and  urethra  aro  to  be  laid  open,  by  cut- 
ting them  through  on  the  upper  part.,  so  as  to  avoid  injuring 
the  points  of  demonstration,  which  are  all  on  the  lower  sur- 
face. 

The  mucous  coat  of  the  bladder  will  be  seen  to  extend 
alon.o-  the  urethra  to  the  glans.  In  the  lower  part  of  the 
bladder,  we  may  perceive  the  entry  of  the  ureters,  and 
those  little  eminences  which  pass  from  them  towards  -the 
ate;  and  which  have  been  proved  by  Mr.  Bell  to  be 
small  muscles  for  regulating  the  opening  of  the  ureters. 

By  squeezing  the  vesiculas,  the  opening  of  their  ducts,  and 

of  the  testicle,  will  be  discovered  by  a  brown   fluid  issuing 

from  an  eminence  on  the  anterior    part   of  the  prostate, 

u  though  called  the  verumontanum,  or  caput  gallinagi- 

-  only  a  loose  portion  of  the  internal  membrane,  which 

ots  so  as  to  form  a  pouch,  or  sinus,  that  opens  towards 

the  glans.     The   cavity  formed  by  it   has  been  called  sinus 

igni,  or   sinus   pocularis.      By   blowing   towards   th<- 

biaddev,  the  membrane  will  be  raised  ;  but  the  vesicular  will 

not  be  distended,  as  is  generally  supposed,  for  their  ducts  do 

not  open  into  the  sinus,  but  on  each  side  of  the  membrane. 


76 

By  squeezing  the  body  of  the  prostrate,  we  shall  so* 
white  secretion  issuing-  by  a  number  of  ducts  on  each  side  of 
the  verumontanum.     By  a  little  care  we  may  pass  bristles 
into  the  ducts  ot'Cowper's  glands;  but  they  are  very  small, 
and. are  situated  about  half  an  iruvh  anterior  to  the  bulb. 

On  the  surface  of  the  'urethra,  we  shall  discover  many 
small  openings,  that  are  called  lacunae:  but  the  principal 
one,  which  is  called  lacuna  magna,  is  sometimes  destroyed 
in  making  the  section  of  the  urethra, — for  it  is  situated  on 
the  upper  surface,  about  an  inch  from  the  opening  of  the 
oflans. 

The  cellular  structure  of  the  eavernous  body  surrounded 
by  the  ligamenr.ons  membranes,  and  divided  into  two  por- 
tions by  the  septum  pectiniforme,  will  now  be  understood. 
No  muscular  fibres  will  be  seen  in  the  membrane  of  the  ure- 
thra; but  the  appearance  which  has  been  described  as  mus- 
cular, may  be  easily  understood  by  pulling  the  membrane  in 
its  length, — for  then  the  inner  membrane  will  be  thrown  into 
folds,  having  the  appearance  of  fibres.  There  is,  likewise,  a 
set  of  vessels  immediately  below  the  membrane,  which,  when 
empty,  are  very  similar  in  appearance  to  muscular  fibres.  I 
have  discovered  that  tkese  vessels  form  an  internal  spongy 
body,  which  passes  d"\vn  to  the  membranous  part  of  the  ure- 
thra, and  forms  even  a  small  bulb  there.  This  I  have  par- 
ticularly described  in  the  tenth  volume  of  theMedico-CIiirur- 
ffical  Transactions. 

Sir  Kverard  Home  has  lately  given  an  account,  in  the 
Transactions  of  the  Royal  Society,  of  certain  muscular 
fibres,  which  he  thinks  he  has  discovered  in  the  urethra  by  the 
aid  of  a  very  powerful  microscope;  but  as  he  has  described 
them  as  muscles,  the  ten'lons  of  which  are  of  the  consistence 
nf  niuf'H'^  we  cannot  suppose  that  any  spasmodic  affection  of 
such  muscles  will  account  for  the  occasional  difficulty  of  in- 
troducing a  bougie  into  the  urethra.  I  suspect  that  SirEve- 
rard  has  been  mistaken  in  supposing  that  there  are  any  mus- 
cular fibres  in  the  urethra,  for  he  does  not  seem  to  have  been 
acquainted  with  my  discovery,  although  it  was  published  two 
years  previous  to  his  paper  being  read  to  the  Royal  Society. 
Since  I  described  the  minute  structure  of  the  urethra,  in  man, 
in  the  horse,  and  in  the  bull,  I  have  had  an  opportunity  of 
verifying  my  opinions,  by  the  dissection  of  the  same  part,  in 
the  elephant  and  camel. 

1  shall  now  describe  the  manner  in  which  the  more  advan- 
ced student  should  make  the  dissection  of  the  parts  int.hr 
perineum,  so  as  to  enable  him  to  understand  their  pathology, 
and  the  operations  which   it  may  be  necessary  to  peri' 
upon  them. 


77. 

The  arteries  of  the  pelvis  are  to  be  injected.  The  bod} 
is  to  be  put  into  the  same  position  as  that  for  the  first  dissec- 
tion ;  but  before  this  is  done,  the  student  may  try  to  intro- 
duce the  catheter  into  the  bladder, — taking  care  to  do  it 
lightly,  so  that  he  may  not  break  through  any  of  the  natural 
obstructions  to  the  entry  of  the  instrument. 

The  body  being  put  into  the  proper  position,  a  single  cut. 
is  to  be  made  in  the  line  of  the  Raphe,  and  the  skin  only,  is 
to  be  dissected  off  to  wards  each  rarnus  of  the  pubes  and  is- 
ehium,  so  as  to  expose  the  superficial  fascia  of  the  perineum, 
which  is  strongly  united  by  firm  cellular  membrane  to  the 
fascia  that  covers  the  gracilis  and  adductor  muscles  of  the 
thigh, — more  loosely  to  the  parts  about  the  anus,  and  still 
less  so  to  the  cellular  membrane  of  the  scrotum.*  The  first 
circumstance  that  will  naturally  excite  the  attention  of  the, 
*iirgical  student,  is,  that  if  matter  should  form  under 
this  fascia,  it  will  with  difficulty  gain  an  exit; — but  his  inte- 
rest, will  be  increased,  when  he  recollects  the  quantity  of 
loose  cellular  membrane  which  he  found  among  the  muscles 
of  the  perineum,  in  his  first  dissection  :  for  be  will  see,  that 
if  an  abscess  under  this  fascia  is  not  freely  opened,  the  mat- 
tor  may  work  its  way  backwards  into  the  cellular  membrane, 
so  HS  to  do  irreparable  mischief  to  the  parts  within.  But 
?ttf  most  important  view  in  which  this  fascia  is  to  be  consid- 
tTfrl,  is  in  the  case,  where,  after  rupture  of  the  urethra,  the 
urine  is  effused  into  the  parts  of  the  perineum.  As  the  urine 
cannot,  in  such  a  case,  torce  a  passage  through  the  fascia,  it 
will  be  driven  up  among  the  loose  cellular  membrane  of  tlu 
penis  and  scrotum :  and  here  it  will  very  quickly  produce 
gangrene,  unless  a  free  incision  is  made  through  the  fascia. 

There  are  very  few  vessels  seen  in  this  stage  of  the  dis- 
section; but  after  part  of  the  fascia  is  cut  through,  the  arte- 
"i<-s,  which  are  called  superficial  perinei  and  transversal!?, 
will  be  seen,  the  first  passing  up  between  the  ejaculator  and 
the  erector, — the  other  running  in  the  line  of  the  trans versn- 
3i*  muscle.  Both  of  these  vessels  must  be  cut,  in  the  opera- 
tion of  lithotomy  ;  but  the  bleeding  from  these  small  arteries 
may  be  of  service  after  such  an  operation. 

The  superficial  fascia  may  now  be  raised,  and  then  the 
muscles  which  were  described  in  the  first  dissection,  will  In 
seen. 

After  the  muscles  and  arteries  have  been  dissected,  tht 
parts  should  be  studied  with  reference  to  the  operation  ot 

*  The  observations  which  were  made  on  fascice  at  the 
.«rroin,  are  also  applicable  to  this  fascia.  If  the  subject  be 
<Uf-:  the  fuscia  will  be  very  indistinct. 


78 

lithotomy.  In  doing  this,  it  is,  above  all  things,  irecessarv. 
that  we  should  observe  in  the  skeleton  the  form  of  the  arch 
which  is  made  by  the  rami  of  the  pubes  and  ischinm,  and 
examine  its  width, — and  then  calculate  the  space  which 
would  be  occupied  by  the  common  sized  forceps,  with  only  a 
ssmall  stone  b9tween  the  blades.  It  will  at  once  be  evident, 
that  an  incision  made  high  in  the  arch  must  be  useless, — for 
the  upper  part  of  the  arch  is  not  only  too  narrow  to  permit 
the  forceps  to  be  extracted  with  a  stone  within  their  grasp? 
but,  in  the  living  body,  it  is  filled  up  by  a  strong  ligament. 
This  view  of  the  bony  arch,  will  prove, 'that  the  upper  part 
of  the  incision  need  not  be  higher  than  through  the  transver- 
salis  muscle  ;  and  consequently,  that  neither  the  ejaculator 
nor  the  erector  should  be  cut.  The  first  incision  of  a  good 
lithotomist  extends  from  the  upper  edge  of  the  transver- 
salis  to  below  the  anus.  It'  we  examine  the  parts  in  the 
line  of  such  an  incision,  we  shall  see  that  the  greater  part 
of  it  may  be  made  very  boldly,  for  it  must  pass  through  the 
mass  of  fat  that  is  between  the 'rectum  and  ischium,  and  in 
which  there  are  no  vessels  of  importance.  If  we  remove 
this  fat,  we  shall  see,  that,  in  the  second  incision,  the  leva- 
tor  ani  must  be  freely  cut,  before  a  stone  can  be  easily  and 
safely  extracted. 

As  the  arteries  have  been  injected,  we  may  already  see, 
that  if  the  first  incisions  be  properly  made,  that  there  can  be 
no  danger  of  haemorrhage.  The  small  arteries  have  been  al- 
ready noticed.  The  first  artery  of  importance  which  is  found 
in  the  perineum,  is  that  of  the  bulb,  and  which  may  be  dis- 
covered by  dissecting  above  the  transversalis  muscle.  For 
the  reasons  already  given,  this  artery  ought  never  to  be  cut  : 
it  is  too  high  up.  If  we  trace  this  artery  back  towards  the 
ramus  of  the  pubes,  we  shall  discover  the  PUDICA  INTERNE, 
from  which  all  the  arteries  of  the  perineum  arise.  When  we 
examine  the  manner  in  which  this  vessel  is  bound  by  a  strong 
fascia,  to  the  ramus  of  the  ischium,  it  will  be  evident,  that  ne 
surgeon,  if  he  has  his  wits  about  him,  can  be  in  danger  of  cut- 
ting it,  if  he  performs  the  operation  with  the  scalpel.  When 
the  artery  is  cut,  it  must  be  by  a  careless  introduction  of  the 
gorget,  or  in  withdrawing  the  bistoure  cachee  through  the 
upper  part  of  the  arch.  Before  we  leave  this  view,  it  may 
be  remarked,  that  there  is  another  good  reason,  besides  those 
already  given,  for  making  the  incisions  low,  viz.  that  the 
urine  will  be  prevented  from  lodging,  after  the  operation,  and 
producing  abscesses, — which  it  is  very  liable  to  do,  when  the 
incisions  are  made  high  in  the  perineum. 

It  is  not  easy  to  pass  an  instrument  into  the  bladder  while 
•?ody  is  in  this  position,  but  we  ought  to  try  and  introduce 


79 

a  catheter  ;  for  there  are  certain  points  of  the  anatomy  that 
may  be  more  easily  demonstrated  now,  than  when  the  body 
is  laid  upon  its  back.  The  manner  of  avoiding  the  sinus  at 
the  bulb,  was  pointed  out  in  the  first  dissection  ;  but  we  may 
still  be  foiled  in  the  attempt  to  introduce  the  instrument, 
even  though  we  attend  to  the  rule  of  withdrawing- it  from 
the  sinus,  and  elevating  its  point  before  we  push  it  on.  To 
discover  the  cause  of  our  difficulty,  we  should  remove  all  the 
muscular  fibres  which  surround  the  bulb,  and  then  we  shall 
see,  that  the  instrument  may  not  only  have  struck  against 
the  edge  of  the  triangular  ligament,  by  being  elevated  too 
much,  but  that  the  urethra  becomes  very  much  narrowed  at 
this  part,  and  passes  through  a  circular  ligament,  which  i~ 
formed  by  a  fascia  that  descends  from  the  triangular  liga- 
ment to  the  rectum. 

It  will  now  be  evident  that  there  are  several  causes  of  dif- 
ficulty to  the  introduction  of  an  instrument  through  this  part 
of  the  urethra — 1-st.  The  natural  curve  of  the  canal — 2d. 
The  sinus  of  the  bulb — 3d.  The  edge  of  the  triangular  liga- 
ment :  but  the  principal  difficulty  is  caused  by  the  circular 
ligament  which  surrounds  the  narrow  part  of  the  canal. 

It  requires  so  much  management,  and  such  a  knowledge  of 
the  structure  of  this  part,  to  pass  an  instrument  nicely  through 
it,  that  I  can*  now,  with  confidence,  assert,  that  nine  cases 
out  of  ten  of  the  strictures  that  are  said  to  exist  here,  are  a 
consequence  of  this  natural  narrowing  of  the  canal  having 
been  mistaken  for  stricture.  I  am  now,  by  experience,  so 
satisfied  of  this,  that  when  a  patient  comes  to  me  complaining 
of  stricture  only  at  this  part, — if  he  has  been  examined  by 
another  surgeon,  a  short  time  before,  I  beg  him  to  let  the 
urethra  have  some  days  rest  before  I  sound  him ;  for  this  part 
of  the  canal  is  so  irritable,  that  if  there  has  been  the  slightest 
injury  done  to  the  membrane,  there  will  be  a  spasmodic  at- 
fection  produced  the  moment  the  bougie  touches  it,  so  as  to 
lead  the  patient  to  believe  that  the  difficulty  of  introducing 
the  instrument  is  in  consequence  of  a  stricture.  But  there 
is  another  source  of  error  here, — for  the  end  of  the  bougie 
may  be  indented  by  being  pressed  against  the  edge  of  the 
ligament,  so  as  to  give  exactly  that  appearance  which  has 
been  considered  as  an  unequivocal  proof  of  the  existence  of 
stricture.  When  the  body  is  untied,  we  should  again  exam- 
ine these  causes  of  obstruction. 

Before  making  the  section  of  the  pelvis,  we  should  observe 
the  relation  of  the  bladder  to  the  parieties  of  the  abdomen. 
If  the  muscles  of  the  abdomen  are  still  entire,  we  should  dis- 
tend the  bladder,  so  as  to  make  it  project  above  the  pubes, 
•iocs  in  a  case  of  retention  of  uruie  ;  then,  by  making- 


80 

an  incision,  two  inches  in  length,  upwards  from  the  pube?-, 
v;e  shall  see  the  space  in  which  we  ought  to  enter  our  trochar 
in  puncturing  the  bladder  ; — here  also  is  the  place  in  which 
the  cut  is  to  be  made,  for  extracting  a  stone  by  the  high  ope- 
ration, if  it  should  be  deemed  necessary.  We  may  now  cut 
through  the  muscles  of  the  abdomen,  at  the  umbilicus,  and 
then  we  shall  see  that  the  peritoneum,  when  the  bladder  is 
distended,  is  removed  to  a  considerable  distance  from  the 
pubes.  I  have  already,  in  the  dissection  of  the  abdomen,  des- 
cribed the  inflections  of  the  peritoneum ;  but  before  removing 
any  part,  the  hand  may  be  passed  down  between  the  bladder 
and  rectum, — and  then  it  may  be  understood  how  a  hernia 
may  take  place  there.  The  peritoneum  is  then  to  be  strip- 
ped from  the  anterior  and  upper  part  of  the  bladder,  on  both 
sides  ;  the  vasa  deferentia  may  be  cut  or  left  as  we  choose. 
Vart  of  the  air  and  water  should  be  pressed  from  the  bladder, 
and  then  its  anterior  ligaments  will  be  observed. 

The  obturator  muscles  will  now  be  brought  into  view,  co- 
vered by  a  fascia,  which  may  be  traced  towards  the  bladder. 
But  this  will  be  more  distinctly  seen,  when  we  have  made  the 
vertical  section  of  the  pel-vis* 

In  making  this  section,  we  should  cut  through  the  parts  in 
the  perineum,  nearly  in  the  yame  manner,  as  described  in  the 
first  dissection  ;  but- we  must  now  take  care  to  preserve  as 
many  of  the  arteries  as  we  can,  and  to  make  our  incisions  to- 
wards the  left  side,  so  that  we  may  not  endanger  any  of  the 
ligaments  of  the  urethra.  The  bone  is  to  be  sawed  through, 
at  a  little  to  the  left  of  the  symphysis  puhis.  The  peritone- 
um is  then  to  be  stripped  from  the  left  side  of  the  pelvis,  so 
as  to  completely  expose  the  fascia  which  covers  the  levator 
«.ni,  and  obturator  internus.  After  these  muscles  and  tin* 
pyriformis,  &c.  are  cut  through,  in  the  manner  which  is  de- 
scribed in  the  first  dissection,  the  left  leg  is  to  be  pulled  off, 
at  the  sacro-iliac  yymphysis. 

While  making  this  section,  we  should  particularly  observe 
the  manner  in  which  the  fascia  passes  from  the  obturator 
muscle  to  the  neck  of  thebladder  ;  for,  as  it  forms  a  sort  of 
natural  division  between  the  external  and  internal  parts  of 
the  pelvis,  it  has  been  imagined  by  some,  that  if  it  were  pos- 
ssible  to  perform  the  operation  of  lithotomy  without  cutting 
this  fascia,  that  there  would  be  no  danger  of  infiltration  of 
urine,  after  the  operation.  But,  unfortunately,  experience 
proves  to  us,  that  it  is  impossible  to  perform  the  operation 
without  cutting  it.*  When  the  section  is  completed,  this 

*  I  have  -endeavored,  in  a  paper  printed  in  the  Quarterly 
Journal  of  Foreign  Medicine  and  Surgery,  in  January,  182  K 


81 

fascia  may  be  traced  to  the  surface  of  the  lateral  part  of  the 
bladder,  and  to  the  vesiculte  seminales  :  here  it  is  called  fas- 
cia, vesiculis.  But  there  is  also  another  portion  of  fascia, 
which  has  a  firm  attachment  to  the  syrnphysis  pubis,  and  pas- 
ses down  to  the  prostate  ;  it  will  be  made  more  distinct,  by 
depressing  the  prostate,  towards  the  rectum,  with  the  staff. 
It  will  then  appear  to  form  a  ligament  to  the  prostate  ;  for  it 
surrounds,  or  rather  is  perforated,  by  the  prostatic  part  of  the 
uretha, — from  which  it  may  be  traced  down  to  the  verge  of 
the  anus.  This  fascia  cannot  be  confounded  with  the  one 
which  passes  from  the  obturator  muscle, — because  the  fibres 
of  the  levator  ani  are  interposed  between  them. 

Before  making  any  further  dissection,  we  should  again 
practise  the  introduction  of  the  catheter.  We  have  already 
noticed  the  difficulty  which  was  produced  by  the  point  of  the 
instrument  falling  into  the  sinus,  at  the  bulb  ;  and  we  have 
also  understood  why  it  is  obstructed  immediately  behind  the 
bulb.  After  having  passed  these  two  impediments,  the  in- 
strument will  enter  easily,  for  three  quarters  or  half  an  inch  ; 
but  there,  it  may  be  obstructed  by  the  fascia  which  we  hav<- 
just  described.  This  difficulty  may  be  overcome  by  raising 
the  point  a  little,  and  by  pushing  the  instrument  forwards, 
recollecting,  at  the  same  time,  the  axis  of  the  pelvis.  The 
point  may  still  be  struck  against  the  edge  of  the  sphincter  of 
rhf.  bladder.  This  is  the  last  cause  of  obstruction  in  a  sound 
urethra,  and  will  be  easily  overcome,  by  depressing  the  han- 
dle of  the  instrument  a  little. 

The  catheter  may  be  left  in  the  urethra.  As  the  fibres  of 
ine  ejaculator  have  been  already  removed,  very  little  dissec- 
tion will  now  be  required  to  show  the  artery  passing  into  the 
bulb — the  Cowper's  glands,  and  the  ligament  through  which 
the  urethra  passes.  If. after  examining  those  parts,  we  re- 
move the  levator  ani  from  its  connection  with  the  upper  part, 
of  the  ramus  of  the  pubes,  we  shall  see.  immediately  behind 
the  circular  ligament,  certain  muscular  fibres,  which  are  co- 
vered by  a  set  of  small  vessels.  These  muscular  fibres  have 
been  described  by  Mr.  Wilson  as  forming  a  distinct*  muscle, 
which  surrounds  the  membraneous  part  of  the  urethra.  That 
there  are  muscular  fibres  here,  no  one  will  deny;  but  it  will 
b»>  tbund  very  difficult  to  give  them  the  appearance  of  a  neat 
small  muscle,  such  as  have  been  described  by  him,  and  at 
the  same  time  to  preserve  the  ligaments  of  the  urethra  and  of 
*  he  prostate,  and  also  the  levator  prostatae  muscle. 

to  show  the  true  cause  of  the  infiltration  of  urine  into  thw 
f-ellular  membrane,  after  the  operation  of  lithotomy. 


82 

There  is  not  any  farther  dissection  required,  to  enable  us 
to  comprehend  the  incisions  which  are  made  through  the  in- 
ternal parts,  in  the  operation  of  lithotomy.  The  cut  which  is 
made  by  the  best  operators,  begins  about  the  middle  of  the 
membranous  part  of  the  urethra,  and  is  continued,  in  a  lateral 
direction,  through  the  prostate  and  the  sphincter  of  the  blad- 
der, above  the  level  of  the  vesicula  seminalis.  By  the  view 
of  the  parts  before  us,  we  may  be  convinced  that  in  such  an 
incision*  no  arteries  of  importance  will  be  cut.  The  bleed- 

*  It  is  to  be  hoped  that  the  prejudice  in  favor  of  the  gorget, 
will  now  give  way  to  the  use  of  the  knife,  in  the  operation  of 
lithotomy.  The  ease  and  safety  with  which  the  operation 
with  the  scalpel  may  be  performed,  in  comparison  with  that 
by  the  gorget,  is  admirably  shown  in  the  illustrations  of  the 
( ireat  Operations  of  Surgery,  by  Mr.  Charles  Bell.  Mr. 
Bell  has,  in  his  Surgical  Observations,  published  some  time 
ago,  given  proofs  of  the  success  attending  his  mode  of  opera- 
ting ;  but  they  have  been  lately  corroborated,  in  an  extraor- 
dinary degree,  by  the  history  which  that  excellent  surgeon, 
Martineau,  of  Norwich,  has  given,  in  the  Medico  Chirurgic- 
ul  Transactions,  of  more  than  eighty  cases  of  lithotomy,  in 
which  he  performed  the  operation  nearly  in  the  same  man- 
ner. 

As  to  the  question  of  the  high  operation,  I  shall  refer  to 
the  remarks  which  I  have  made  upon  it  in  the  Journal  of  Fo- 
reign Medicine  and  Surgery,  where  I  hope  I  have  proved, 
that  it  is  not  only  a  very  dangerous,  but  also  a  more  difficult 
operation  to  perform,  than  the  lateral.  Although  the  ob- 
servations which  I  have  wade  in  that  paper,  have  by  somf 
been  thought  more  severe  than  the  occasion  called  for,  yet  1 
have  been  mucli  gratified  and  flattered  by  the  manner  in 
which  several  surgeons  of  great  eminence  and  learning  have 
spoken  of  them.  But  nothing  has  given  me  so  much  plea- 
sure as  to  find  that  my  opinions  coincide  with  those  of  Mr. 
Martiaeati,  who,  I  have  been  informed,  was  pleased  to  say, 
••  that  he  was  sorry  he  had  not  read  my  observations  before 
ho  wrote  his  paper  upon  lithotomy,  as  he  had  taken  the  same 
view  of  the  question  of  the  high  operation  as  I  had." 

In  the  same  paper  I  have  dwelt  at  some  length  on  the  ques- 
t  ion  of  haemorrhage,  after  the  common  lateral  ^operation.  At 
the  time  I  wrote  that  paper,  I  thought  that  the  fears  of  hae- 
morrhage, which  are  entertained  by  some  surgeons,  were 
groundless ;  but  I  have  since  had  an  opportunity  of  examin- 
ing a  body  upon  which  the  lateral  operation  had  been  per- 
formed :  in  the  dissection  of  this  body  I  discovered  a  good 
reason  for  these  fears ;  for  the  incision  had  been  begun  immr- 


83 

ing  which  takes  place  in  an  operation  that  has  been  well  per- 
ibrmed,  will  be  principally  from  the  large  veiiis  which  may  be 
been  surrounding  the  prostate  and  neck  of  the  bladder. 

The  next  practical  question  founded  directly  on  the  anato- 
my, is  the  point  through  which  the  puncture  of  the  bladder  is 
to  be  made  from  the  rectum. 

After  the  bladder  has  been  fully  distended  with  water,  thf 
finger  should  be  passed  into  the  rectum,  that  we  may  form 
some  idea  of  the  feel  of  a  distended  bladder.  It  is  very  diffi- 
cult, even  in  the  healthy  state  ofthe  parts,  to  distinguish  be- 
tween the  prostate^  the  vesieulae,  and  the  muscular  coat  of 
the  bladder;  but  if  there  be  much  cellular  membrane  inter- 
posed between  the  bladder  and  rectum, — and  if  the  coats  of 
the  bladder  be  thickened,  as  they  generally  are  in  tlio**'  <•»•• 
ses  which  require  the  bladder  to  be  punctured,- — I  belie vf 
that  it  will  be  found  almost  impossible  to  recognize  the  diil'e- 
rent  parts,  so  as  to  mark  the  boundaries  of  that  triangle  whk-h 
is  described  as  having  the  peritoneum  for  its  base,  the  vasa. 

duttely  below  the  arch  of  the  pub es,  and  had  not  been  continued 
further  down  than  the  upper  part  of  the  transversalis  muscle, — 
and  even  this  muscle  had  not  been  cut  through.  Now,  it  it- 
easy  to  understand,  that  by  such  an  operation,  it  must  be  al- 
most impossible  to  avoid  cutting  some  important  arteries. 

If  this  middle  operation  (as  it  was  called  by  a  young  friend 
of  mine)  were  the  one  generally  performed  as  the  lots  opera- 
tion, it  would  not  then  be  surprising  that  some  gentlemen 
should  have  a  desire  to  change  the  mode  of  operating ;  for 
instead  of  the  stone  being  easily  extracted,  as  it  may  be, 
when  the  operation  is  performed  low  in  the  perineum,  it  will 
be  pulled  by  the  forceps  against  thte  rami  of  the  pubes, — .so 
that  the  patient  may  be  dragged  ofi'the  table  before  the  si  on* 
is  extracted.  If  the  stone  should  be  extracted  by  such  an 
incision,  the  chances  are,  that  some  of  the  vessels  will  be 
cut,  and  the  patient  die  of  haemorrhage :  if  he  escapes  this 
danger,  he  may  still  be  in  jeopardy  in  consequence  of  the 
urine  not  having  a  depending  opening  by  which  it  may  easily 
pass  off  after  the  operation. 

When  discussing  the  operation  of  lithotomy  with  some  of 
the  young  students  in  the  dissecting-room,  I  have  very  often, 
put  this  question  when  the  body  is  before  them, — "  What  is 
vour  object  in  performing  the  operation  of  lithotomy?" 
Though  this  question  is  considered  rather  insulting,  still  if 
leads  them  to  form  a  correct  notion  of  one  of  the  great  prin- 
ciples ofthe  operation,  viz.  to  cut  low  in  the  perineum,  that 
the  extraction  ofthe  stone  may  not  Ire  obstructed  by  thr 
narrow  part  of  the  bony  arch. 


84 

deferentia  for  its  sides,  and  the  prostate  for  its  apex.  When 
I  have  made  this  examination  in  a  patient  labouring  under 
retention  of  urine,  I  confess  that  my  impressions  have  been, 
that  it  must  be  by  chance  only  that  all  these  parts  can  b<> 
avoided  in  puncturing  the  bladder  :  however,  it  is'  some  re- 
lief to  know,  that  in  such  a  case  the  peritoneum  will  be  re- 
moved to  a  greater  distance  than  we  would  venture  to  push 
our  instrument  in. 

The  peritoneum  and  the  vasa  deferentia  may  be  consider- 
ed as  the  only  parts  which  it  is  of  much  importance  to  avoid 
in  this  operation ;  for  it  is  only  by  those  dissectors  who  have 
not  attended  to  the  practice  of  surgery,  that  much  import- 
ance, can  be  attached  to  the  wounding  of  the  prostate. 

We  should  now  take  the  opportunity  of  practising  the  ope- 
ration of  sounding.  A  stone  may  be  put  into  the  bladder, 
through  an  opening  in  the  fundus,  which  is  to  be  closed,  and 
the  bladder  is  to  be  again  filled  with  water. 

When  the  sound  is  in  the  bladder,  we  should  try  to  pass  it 
in  several directions,  as,  round  the  stone,  and  over  it,  and  be- 
low  it,  so  that  we  may  attain  some  idea  of  the  sensation  which 
is  given  to  the  hand  by  a  stone  of  a  particular  shape,  and  in 
the  different  parts  of  the  bladder.  The  finger  should  be 
passed  into  the  rectum,  and  then  the  stone  should  be  pressed 
clown  towards  it,  so  that  we  may  see  the  possibility  of  esti- 
mating the  size  of  a  stone  in  the  living  body,  by  having  it  be- 
tween the  sound  and  the  finger.  The  operation  of  sounding 
is  so  important  a  step,  previous  to  performing  the  operation 
of  lithotomy,  that  we  should  pay  particular  attention  to  it. — 
Indeed,  by  a  good  surgeon,  this  is  always  considered  as  the 
most  important  part  of  the  operation.  There  is  an  excellent 
plate,  demonstrative  of  the  various  positions  which  the  stone 
may  take  in  the  bladder,  given  in  the  illustrations  of  the 
Great  Operations  of  Surgery. 

Before  we  open  the  urethra,  to  examine  the  several  points 
at  which  the  catheter  has  been  obstructed,  we  should  pas? 
one  down  to  the  sinus  of  the  bulb.  While  it  is  held  there  by 
an  assistant,  the  urethra  is  to  be  opened,  and  then  the  point 
of  the  instrument  will  be  seen  lodged  in  the  sinus.  In  this 
view,  we  shall  see  that  the  part  of  the  urethra  which  is  sur- 
rounded by  the  circular  ligament,  has  so  much  resemblance 
to  a  stricture,  that  we  can  now  easily  comprehend  how  it 
may  be  mistaken  for  one  in  the  living  body. 

If  in  pushing  the  instrument  towards  the  bladder,  we  de- 
press its  point,  it  will  again  be  impeded:  if  we  lay  open  the 
Urethra,  up  to  the  point  of  obstruction,*  we  shall  find  that  it 

*  The  great  size  of  the  cavity  of  the  urethra,  posterior  to 


ir-'  (Caused  by  the  fascia  of  the  prostate.  By  now  carrying  th« 
catheter  forwards,  it  will  fall  into  the  sulcus  which  is  by  the 
side  of  the  verumontanum,  and  anterior  to  the  sphincter  oi 
the  bladder. 

These  are  all  the  obstructions  to  the  passage  of  the  cathe- 
ter, which  will  be  found  in  the  dead  body  ;  but  in  the  living 
body,  it  is  a  very  common  occurrence  for  the  surgeon  to  be 
foiled  in  his  attempt  to  introduce  the  catheter  through  the 
part  behind  the  bulb, — not  so  much  on  account  of  the  me- 
chanical difficulty,  as  in  consequence  of  there  being  very  fre- 
quently a  spasmodic  action  of  the  muscles  which  surround 
this  portion,— for  it  is  not  only  the  narrowest,  but  also  tlu- 
most  irritable  part  of  the  canal. 

While  the  view  of  the  section  of  the  pelvis  is  before  us,  we 
should  also  take  into  consideration  the  operations  to  be  per- 
formed upon  the  rectum.  If  the  gut  be  cut-in  the  operation 
for  fistula  in  ano,  as  far  up  as  the  linger  will  reach,  we  cannot, 
be'surprised  that,  after  such  an  operation,  a  patient  should 
die  of  haemorrhage;  because,  by  such  a  cut,  not  only  very 
large  branches  of  the  pudic,  but  even  of  the  lower  mes-enteric 
artery,  may  be  divided.  But,  luckily,  experience  has  taught 
us  that  it  is  very  seldom  necessary  to  cut  more  than  the 
sphincter  ani,  in  this  operation.  We  have  only  to  look  to 
the  curve  which  the  rectum  makes,  to  avoid  falling  into  the 
error  of  supposing,  that  the  difficulty  which  is  offered  by  the, 
sacrum  to  the  passing  of  a  bougie,  farther  than  six  inches  into 
the  rectum,  is  caused  by  a  stricture  in  the  gut. 

If  we  examine  the  rectum  with  the  finger,  we  shall  find 
that  there  is  a  natural  constriction  about  half  an  inch  above 
the  verge  of  the  anus, — here  the  cuticle  appears  to  terminate, 
and  the  mucous  coat  of  the  intestine  to  commence. 

If  we  inject  the  lower  mesenteric  veins  with  size,  we  shall 
be  able  to  form  some  idea  of  the  nature  of  piles :  for,  in  the 
greater  number  of  bodies,  the  vein  will  appear  constricted  at 
the  point  of  union  between  the  mucous  coat  and  the  cuticle, 
and  distended  below  it,  so  as  to  resemble  piles  in  an  early 
stage  of  their  formation.  Immediately  above  this  point,  the 
gut  becomes  more  dilatable :  and  here  it  is  that  fish  bones,  or 
the  stones  of  fruit,  after  having  passed  easily  through  the 

the  ligament  of  the  bulb,  will  explain  to  us  the  difficulty  often 
experienced  in  the  attempt  to  introduce  the  beak  of  the  gor- 
get into  the  groove  of  a  small  staff.  It  is  evident,  that  the 
dides  of  the  urethra  must  fall  together  when  cut ; — a-  diffi- 
culty which  is  completely  obviated  by  the  large  staff  which 
is  used  by  Mr.  Bell. 

H 


86 

whole  intestinal  canal,  are  liable  to  lodge,  and  occasionally 
to  cause  abscess  and  fistula. 

The  knowledge  of  the  changes  which  take  place  in  the 
urethra  and  bladder,  in  consequence  of  disease,  is  most  im- 
portant; but,  as  it  would  require  a  volume  to  detail  all  the 
morbid  appearances  which  are  found  in  the  urethra  and  blad- 
der, I  dare  not  enter  upon  the  subject,  farther  than  to  point 
out  one  or  two  circumstances  which  have  been.provedby  the 
dissection  of  the  bodies  of  those  who  have  died  in  consequence 
of  stricture.  I  confine  myself  to  this,  the  more  willingly,  be- 
cause I  can  conscientiously  recommend  to  the  student  the 
perusal  of  the  observations  which  have  been  made  on  the 
morbid  anatomy  of  the  urethra  and  bladder,  in  that  edition  of 
the  work  on  Stricture,  by  Mr.  Bell,  of  which  I  was  the 
editor. 

Stricture  may  -take  place  at  any  part  of  the  urethra  ante- 
rior to  the  triangular  ligament,  but  ingerieral  it  occurs  at  two 
points  : — at  an  inch  and  a  half  from  the  glans,  and  at  six  or 
seven  inches  down,  i.  e.  near  the  bulb.  But  I  have  already 
given  sufficient  reasons  for  our  being  guarded  in  supposii;£f. 
that  an  obstruction  to  the  passage  of  an  instrument  at  the 
bulb,  is  produced  by  a  stricture. 

There  are  two  circumstances,  not  hitherto  much  noticed, 
to  which  I  would  particularly  direct  the  student's  atten- 
tion : — 

1st.  That  there  is  n'ot  one  example  in  a  hundred  of  stric- 
ture occurring  farther  back,  than  immediately  behind  the 
ligament  of  the  bulb. 

2d.  That  the  ducts  of  the  prostate,  which  are  naturally 
very  small,  are  always  more  or  less  enlarged  in  cases  « 
vere  stricture. 

It  must  be  evident  that  certain  practical  rules  are  to  be  de- 
duced from  these  facts.  1st,  If  an  instrument  is  obstructed 
posterior  to  the  ligament  of  the  bulb,  that  we  may  suspect 
that  the  cause  of  the  obstruction  is  not  such  as  will  'be  over- 
come by  the  same  means  as  a  stricture  would ;  and  2d,  Wr 
can  now  understand  why,  in  a  severe  case  of  stricture,  we 
ought  to  be  content  with  so  dilating  the  stricture,  as  to  ena- 
ble the  patient  to  pass  his  urine  freely, — and  that  we  should 
not  be  too  anxious  to  pass  an  instrument  into  the  bladder, 
for;  in  the  attempt,  the  point  may  enter  into  one  of  the  en- 
larged ducts  of  the  prostate,  and  consequently  produce  great 
irritation,  and  even  lead  us  to  suspect  that  there  is  still  ano- 
ther stricture:  if,  with  this  idea,  we  persevere  in  pushing  the 
instrument  on,  we  shall  certainly  do  irreparable  mischief  fa* 
the  patient. 


87 

The  urine  is  very  often  obstructed  in  old  men,  either  by 
general  or  partial  enlargement  of  the  prostate.  But  as  this 
disease  cannot  be  understood  by  the  appearance  of  the  natu- 
ral parts,  and  as  it  is  too  important  a  subject  to  be  treated  of 
in  so  short  a  manner  as  the  limits  of  this  book  would  permit, — 
I  shall  only  remark^  that  I  think  I  have  proved,  by  repeated 
dissections,  that  the  obstruction  is  seldom,  or  never,  produced 
by  the  enlargement  of  the  third  lobe,  as  is  generally  sup- 
posed. Some  years  ago  I  wrote  a  paper  on  this  question, 
which  is  published  in  Mr.  Bell's  Surgical  Observations. 

As  in  all  cases  of  irritation  of  the  urethra,  or  bladder,  the 
muscular  coat  of  the  latter  becomes  thickened,  we  must  not 
be  surprised  if  we  should,  in  the  dissection  of  the  body  of  a 
person  who  had  died  of  stricture,  discover  the  bladder  in  this 
state, — and  even  having  cysts  communicating  with  it ;  for 
when  the  muscular  coat  is  thickened,  it  very  frequently  oc- 
curs, that  a  part  of  the  internal  coat  is  protruded  between  the 
fibres, — and  sometimes  to  such  an  extent,  as  to  give  the  ap- 
pearance of  a  second  bladder.  I  may  also  observe,  that  in 
the  examination  of  such  bodies,  we  must  not  express  astonish- 
ment if  we  discover  the  ureters  to  be  thickened  and  inflamed, 
and  the  kidneys  to  be  tabulated  and  full  of  matter;  for  it  fol- 
lows, almost  invariably,  that  when  the  bladder  is  inflamed, 
the  kidneys  and  ureters  become  also  affected. 

TABLE  OF  THE  MUSCLES. 

The  muscles  which  are  seen  in  the  first  dissection  of  the 
perineum,  are — 

ERECTOR  PENIS.     OR.  The  tuberosity  of  the  os  ischium: 
running  upwards,  it  embraces  the  cms  of  the  penis. 
IN.  The  sheath  of  the  cms  penis. 

EJACULATOR.  OR.  The  crura  penis  and  body  of  the  pe- 
nis, and  the  triangular  ligament :  the  inferior  iibres  run  more 
transversely,  and  the  superior  descend  in  an  oblique  di- 
rection. 

IN.  In  the  middle  of  the  bulb  and  spongy  body  of  the  ure- 
thra ;  and  by  the  tibre-s  of  both  sides  uniting,  the  bulb  is  com- 
pletely enclosed. 

It  is  connected  behind  with  the  fibres  of  the  sphincter  ani 
and  transversalis  muscles ;  these  accordingly  co-operate  in 
their  action. 

TRANSVERSALIS  PERINEL.  OR.  The  tuberosity  of  the  os 
isrhium,  below  the  origin  of  the  erector:  it  runs  trans- 

ely. 
IN.  The  ejaculator  seminis,  and  fore  part  of  the  sphincter  ani. 


88 

TRANSVERSAL  is  ALTER  PERINEI,  OR  OBLIQ.UUS.  OR.  From 
fhe  tuberosity  of  the  ischium,  behind  the  former:  it  run* 
more  obliquely  forwards. 

IN.  The  side  of  the  ejaculator  semthis. 

We  do  not  always  find  both  these  muscles  ; — sometimes 
the  one,  and  not  the  other.  There  is  occasionally  another 
portion  found,  which  has  been  deseribed*as  a  TRANSVERSALIS 
PROFUNDUS  ;  but  it  runs  so  deep  under  the  others,  as  to  be 
generally  described  as  a  part  of  the  levator  ani. 

SPHINCTER  ANI.  This  muscle  consists  of  fibres,  which  en- 
circle the  verge  of  the  anus.  It  may  be  said  to  have  neither 
origin,  nor  insertion  into  any  particular  point ;  but  we  may 
observe,  that  certain  superficial  fibres,  after  encircling  the 
anus,  are  attached,  about  an  inch  above  the  bulb,  to  the 
union  of  the  ejaculator  muscles,  while  a  deeper  set  of  fibres 
are  inserted  into  the  union  between  the  transversalis  and 
ejaculator :  sometimes  a  slip  runs  distinctly  to  this  last  muscle, 
and  is  called  MUSCULUS  LATERALIS  URETHRA.  The  fibres 
posterior  to  the  anus  are  attached,  by  a  distinct  tendon,  to  the 
os  coccygis.  The  lower  set  of  the  muscular  fibres  on  the 
rectum,  have  been  by  some  described  as  forming  an  internal 
sphincter. 

LEVATOR  ANI.  OR.  1.  Os  pubis  and  os  ischium,  within 
the  pelvis,  as  far  as  the  upper  edge  of  the  fbramen  thyroi- 
deum ;  2.  from  the  thin  tendinous  membrane  that  covers  the 
obturator  interims  and  coccygeus  muscles ;  3.  from  the  spi- 
nous  process  of  the  os  ischium.  Its  fibres  run  down  con- 
verging. 

IN.  The  sphincter  ani,  and  verge  of  the  anus,  and  anterior 
part  of  the  two  last  bones  of  the  coccyx.  It  surrounds  the 
extremity  of  the  rectum,  neck  of  the  bladder,  prostate  gland, 
and  part  of  the  vesicula?  seminales. 

USE.  To  sustain  the  contents  of  the  pelvis,  and  to  help  in 
ejecting  the  semen  and  contents  of  the  rectum;  to  restrain 
the  protrusion  of  the  anus  in  evacuation  of  the  faBces. 

I  shall  describe  the  coccygeus  here,  though  it  cannot  pro- 
perly be  considered  a  muscle  of  the  perineum: — 

COCCYGEUS.  OR.  Tendinous  and  fleshy,  from  the  spinous 
process  of  the  os  ischium,  and  the  inside  of  the  posterior  sacro- 
ischiatic  ligament.  From  this  narrow  beginning,  it  gradu- 
ally increases,  to  form  a  thin  fleshy  belly,  interspersed  with 
tendinous  fibres. 

IN.  Into  the  extremity  of  the  os  sacrum,  and  nearly 
the  whole  length  of  the  os  coccygis. 

USE.  To  move  the  os  coccygis  forwards v 


89 

In  dissecting  the  parts  exposed  by  the  section  of  the  pelvic, 
we  may  observe  certain  small  muscles,  the  connections  of 
which  are  so  difficult  to  show,  that  there  are  hardly  two  au- 
thorities who  describe  them  in  the  same  manner,. — so  that 
they  have  been  frequently  a  subject  of  dispute :  they  are,  the 

COMPRESSOR     PRGSTATJE     ami     tile     COMPRESSOR,    Or    LEVATOR 

URETHRA.  According  to  the  best  authorities,  the  compres- 
sor prosta.tse  arises,  in  loose  fibres,'  from  between  the  symphy- 
sis  pubis  arid  the  membrana  obturans ;  it  then  runs  back- 
wards, to  the  prostate  gland  and  vesiculse  seminales.  The 
compressor,  <?r  levator  urethras,  according  to  Mr.  Wilson, 
rises  more  umW  the  arch  of  the  pubes,  and  sends  its  fibres 
downwards,  and  under  the  membranous  part  of  the  urethra, 
sa  as  to  encircle  it.  It  is  easy  to  show,  that  the  fibres  of  the 
fl^ator  urethrse  are  distinct  from  those  of  the  levator  ani ; 
^jpt  their  origin  is  jso  connected  with  the  ligament  of  the  ure- 
thra, that  it  is  very  difficult  to  give  the  muscle  the  forn 
picted  by  Mr.  WiL-on,,  and  at  the  same  time  to  show  the 
ligament  of  the  urethra. 

Though  the  attachments  of  the  bladder  to  the  os  pubis,  arc 
railed  the  tendons  of  the  bladder, — it  is  not  correct  to  -le- 
s-cribe   them  as   the  origins  or   insertion:::  of  the 
;  :-:i  VA,  which  is  the  name  given  to  tlie  muscular  coat  of  the 
bladder. 

The  arteries  which  are  seen  in  the  perineum,  are  almost 
all  branches  of  the  PL- me  :  the  greater  number  of  them  have 
been  already  mentioned, — but  I  shall  recapitulate  them,  in 
the  order  in  which  they  appear  on  dissection.  The  H^MOJI.- 
RHOT DALES  EXTERN^  are  those  branches  which  encircle  the 
anus;  the  TRANSVERSAL  is  I-EKIMCF  is  the  name  given  to  that 
branch  which  runs  across  the  perineum:  the  SUPERFICIAL^ 
PIIRIXKI  passes  up  from  the  last,  along  the  side  of  the  erector 
muscle.  In  the  second  stage  of  the  dissection,  we  snail  dis- 
cover the  ARTERY  OF  THE  HI  LR  :  and  by  feeling  clr.sc-  on  the 
bone,  we  shall  find  the  continued  trunk  of  the  pudic,  v, 
is  here  called  ARTERIA  COMAIUMS  PJ?I*IS  :  this  trunk  di\ 

illtO     the     ARTEJUA     PUO*TM>A     PR«>PAIA,— Which    ClltClV- 

i lie  cavernous  body,  and  into  the  .i;<T< SIA  DOIISAI.IS,  or 
i'i  :  FICI ALI>  pi-:iMs, — which  passe*  towards  the  glails. 

The  deeper  arteries  v\  Inch  arc  set-.n  in  the  lateral  section. 
will  be  described  with  those  of  the  pelvis. 

The  veins  are  here,  as  in  the  other  parts,  named  accord- 
ing to  the  arteries   which  they  accompany.      The   ve. 

'  inth  formed  by  those  coming  from  the  cavernous  body, 
and  the  plexus  of  veins  which  surround  the  prostate  gland, 
should  be  more  particularly  attended  to,  than  the  ^A' 
ones. 


90 

The  nerves  which  are  seen  in  the  first  dissection  of  the 
perineum,  are  branches  of  the  pudic.  The  principal  branch 
is  found  either  above  or  below  the  transversalis  muscle : 
several  smaller  twigs  are  sent  to  the  muscles, — while  the 
trunk  of  the  nerve  passes,  along  with  the  pudic  artery,  into 
the  penis. 

The  parts  within  the  pelvis  are  supplied  with  nerves  prin- 
cipally from  the  hypogastric  plexus, — which  will  be  described 
with  the  nerves  of  the  abdomen. 


DISSECTION 


THE   TESTICLE. 


IT  is  more  important  to  have  an  accurate  idea  of  the  for- 
mation of  the  coats  of  the  testicle,  than  of  the  structure  of 
the  gland  ;  because,  without  this,  we  cannot  form  a  correct 
opinion  upon  the  varieties  of  hydrocele  and  hernia.  But  as 
we  cannot  attain  it,  without  examining  the  testicle  in  its  de- 
scent in  the  foetus,  I  shall,  before  describing  its  structure  in 
the  adult,  point  out  some  of  the  changes  which  take  place 
in  its  coverings,  during  the  existence  of  the  foetus. 

If  we  examine  a  foetus  of  six  months  old,  we  shall  disco- 
ver the  testicle  lying  under  the  kidney,  on  the  fore  part  of 
the  psoee  muscles,  and  covered  by  the  peritoneum,  which 
adheres  to  it,  in  the  same  manner  as  to  the  viscera  of  the  ab- 
domen :  we  may  also  observe  a  ligamentous,  or  cellular  cord, 
which  stretches  up  from  the  inside  of  the  abdominal  ring  to 
the  body  of  the  testicle, — this  is  the  GUBERNACULUM  TESTJS. 

In  a  foetus  at  the  eighth  month,  we  shall  probably  find  the 
testicle  lying  in  the  inguinal  canal,  and  a  small  portion  of 
peritoneum  projecting  before  it,  towards  the  scrotum.  But 
if  we  examine  a  child  at  the  period  of  birth,  or  a  short  time 
after  it,  the  testicle  will  be  found  in  the  scrotum*  and  covered 
by  two  portions  of  peritoneum ;  the  most  superficial,  is  the 
same  as  that  which,  iu  the  foetus  of  eight  months,  projected 


91 

into  the  inguinal  canal, — the  other,  which  adheres  to  the 
body  of  the  gland,  is  the  same  which  covered  the  tgs&eiu 
while  it  lay  in  the  loin.  If,  at  this  period,  a  probe  be"push- 
ed  upwards  between  the  two  portions  of  the  peritoneum,  it 
will  pass  into  the  abdomen ;  but  in  the  adult,  though  the  two 
portions  of  the  peritoneum  are  still  distinct  from  each  other, 
we  shall  not  be  able  to  pass  a  probe  farther  than  the  upper 
part  of  the  scrotum  ;  because  the  communication  with  the 
abdomen  is  now  closed  by  the  adhesion  of  the  peritoneal 
surfaces. 

I  shall  now  suppose  that  we  are  to  make  a  dissection  of 
the  testicle,  scrotum,  &c.  in  an  adult.  We  are  told,  that 
on  cutting  through  the  skin,  we  shall  see  the  muscle  which 
is  called  the  DARTOS  :  but  although  there  is  an  evident  power 
of  contraction  in  the  skin  of  the  scrotum,  we  shall  seldom  be 
able  to  discover  muscular  fibres  under  it, — but,  instead  of 
them,  a  quantity  of  loose  cellular  membrane,  which  can 
easily  be  inflated  with  air.  In  blowing  this  up,  a  sort  of 
natural  septum  will  be  seen  between  the  two  sides  of  the 
scrotum.  This  cellular  structure  is  very  often  distended  in 
general  anas  area,  or  in  emphysema. — The  distention  of  it  in 
either  of  these  cases,  is  comparatively  harmless :  but  if  it 
be  filled  with  urine,  after  the  bursting  of  the  urethra,  it  will 
be  attended  with  more  danger  ;  for  if  the  urine  be  allowed  to 
lodge,  the  membrane  will  become  quickly  gangrenous,.  The 
scrotum  may  now  be  dissected  off,  so  as  to  show  the  testicle 
and  its  cord.  The  cord  is  composed  of  a  number  of  different 
vessels  and  nerves,  which  are  surrounded  by  a  tissue  of  cel- 
lular membrane,  called  the  TUNICA  VAGINALIS  COMMUNIS. — 
Upon  the  upper  surface  of  this,  are  fche  scattered  fibres  of 
the  cremaster  muscle. 

We  may  now  take  the  testicle  in  our  hand ; — and  if  there 
has  been  no  inflammation  of  the  parts  during  life,  we  shall 
feel  the  body  of  the  gland  slipping  about,  as  if  it  were  con- 
tained within  a  sac.  By  dissecting  on  the  fore  part,  we  may 
open  this  sac,  so  as  to  show  the  gland  lying  within  it. — It  is 
called  the  TUNICA  VAGINALIS  ;  being  the  same  portion  of 
peritoneum  which  we  saw  projecting  into  the  scrotum  before 
the  descent  of  the  testicle.  But  we  shall  now  find,  that 
though  this  is  called  a  sac,  that  it  does  not  contain  the  whole 
testicle,  as  in  a  sheath,  but  only  the  two  anterior  thirds  of 
the  body  of  the  gland,  which  will  be  seen  covered  with  the 
dense  white  glistening  coat,  which  was  formed  by  the  adhe- 
sion of  the  peritoneum  to  it,  while  it  was  within  the  abdo- 
men. This  latter  coat  has,  by  the  best  authorities,  been 
named  "tunica  albuginea,"  but  by  others,  "tunica  vaginali* 
reflexa;"  the  name  "  albuginea"  being-  given  by  them  to  s 


92 

dense  fibrous  matter  which  is  under  this  coat,  and  immedi- 
ately invests  the  testicle.  There  is,  however,  some  difficult} 
in  determining  which  is  the  most  proper  name  :  for  even 
Mailer  is  not  very  distinct  in  his  definition  of  the  two  coats : 
but  I  am  inclined  to  call  the  peritoneal  covering,  the  TUNICA 
ALBUGINEA, — because  the  name  seems  to  have  been  origi- 
nally a  surgical  term,  used  in  describing  the  white  dense 
appearance  of  the  peritoneal  coat  of  the  testicle,  when  the 
s;u-  of  a  hydrocele  was  opened.  It  is  observed  in  Warner's 
Treatise  on  the  Testicle,  that  the  "tunic a  albuginea,  so 
named  from  its  complexion,  is  a  compact,  firm,  white,  strong, 
and  smoothly  polished  membrane.,  having  a  tendinous  ap- 
pearance;" and  Pott,  in  speaking  of  hydrocele,  says,  "this 
fluid,  in  a  natural  and  small  quantity,  serves  to  keep  the  tu- 
nica albuginea  moist,  an  1  to  prevent  a  cohession  between  it 
an:l  the  tunica  vaginalis*" 

The  term  Cw  tunica  vsginalis  reflexa"  is  very  objectionable, 
beccuise,  as  it  is  not  used  by  any  surgical  writers  in  the  de- 
scription of  hydrocele  or  of  congenital  hernia,  it  is  very 
liable  to  lead  a  student  into  great  difficulties  ;  and,  moreover, 
it  is  givon  to  a  part  which  covered  the  testicle,  while  it  was 
yet  within  the  abdomen,  and,  consequently,  before  that  which 
L^  called  -'tunica  vaginalis"  was  formed.  If  we  wish  to  dis- 
tinguish the  two  portions  of  the  peritoneum  which  are 
within  the  scrotum,  wo  may  call  that  one  in  contact  with  the 
body  oT the  testicle,  the  Peritoneal  Covering,  and  the  other. 
the  Reflected  Peritoneal  Coat  of  the  testicle. — as  we  distin- 
guish the  part  of  the  peritoneum  which  covers  the  intestines, 
from  that  which  lines  the  abdominal  muscles. 

By  maceration,  we  may  show  the  -fibrous:  texture  whic 
under  the  peritoneal  covering ;  but  by  this  process  of  dissec- 
tion, we  shall  destroy  all  resemblance  to  a  coat  which   we 
would  call  "  rtlbuginca." 

Before  dissecting  farther,  we  should  consider  the  surgical 
anatomy  of  these  coats.  We  can  now  understand  how,  in 
a  common  hydrocele  of  the  adult,  the  body  of  the  testicle 
will  be  on  the  back  part,  and  the  water  which  is  confined 
between  the  tunica  vaginalis  and  albuginea,  will  form  the 
anterior  part  of  the  tumour.  We  can  also  comprehend 
how,  in  a  child,  where  the  connection  with  the  abdomen  is 
not  closed,  that  there  may  be  a  hydrocele  which  may  be  emp- 
tied by  pressure  and  change  of  position,  but  which  will 
a  win  rdurn  when  the  child  is  put  on  its  legs.  It  is  also 
evident,  that  as  loner  as  this  communication  remains  open, 
that  a  portion  of  the  intestine  may  come  down  into  the  ?r 
between  the  tunica  vaginalis  and  albuginea,  so  as  to  forta 
the  species  of  inguinal  hernia  which  is  called  congenital.. 


93 

In  dissecting  the  cord,  we  shall  sometimes  discover,  that 
part  of  the  peritoneal  surface  has  not  united  firmly,  but  that 
a  species  of  encysted  hydrocele  has  taken  place  in  it. 

We  should  now  proceed  to  examine  the  structure  of  the 
testicle,  as  a  gland.  The  CORD  is  composed  of  arteries, 
veins,  absorbents,  and  the  excretory  duct  of  the  testicle, — which 
are  all  bound  together  by  cellular  membrane  and  the  fibres 
of  the  CREM ASTER.  The  SPERMATIC  ARTERY  is  the  most 
difficult  vessel  to  discover,  as  it  is  very  small.  The  veins  are 
very  numerous,  and  easily  seen.  The  manner  of  showing 
the  absorbents  will  be  described  presently.  As  the  vas  defe- 
rens  feels  like  a  piece  of  whip-cord,  compared  to  the  other 
parts,  there  will  be  no  difficulty  in  finding^  it. 

The  cord  should  now  be  cut  through,  at'  its  exit  from  the 
abdominal  canal ;  but  before  we  attempt  to  demonstrate  the 
course  of  the  vessels  which  convey  the  semen,  we  should  in- 
ject some  mercury  into  the  vas  deferens.  The  quicksilver 
will  very  seldom  pass  into  the  tubuli  teetis,  but  will  generally 
reach  as  far  as  the  rete  testis.  After  the  injection  is  made, 
we  may  remove  all  the  parts  of  the  cord,  except  the  vas 
deferens.  In  cutting  away  the  veins  from  the  body  of  the; 
testicle,  we  may  observe,  that  they  have  a  peculiar  form, 
somewhat  resembling  the  tendrils  of  a  vine, — whence  they 
have  been  described  as  forming  a  CORPUS  PAMPINIFORME  ;  and 
which  is,  from  its  pyramidal  form,  sometimes  called  CORPUS 
PVRAMIDALE:  but  this  is  more  distinct  in  the  testicle  of  the 
bull,  or  ram.  We  shall  now  see,  that  the  vas  deferens,  as 
it  passes  downwards,  becomes  very  much  convoluted ;  and 
that  its  convolutions  lie  on  the  body  of  the  gland, — in  such  a 
manner,  as,  by  the  ancients,  to  have  been  described  as  a  dis- 
tinct body,  under  the  name  EPIDIDYMIS — (didymi,  or  twins, 
being  the  name  given  to  the  testicles.)  The  first  distinct 
turn  which  the  epididymis  takes,  is  on  the  lower  part  of  the 
testicle  :  and  here  it  forms  a  little  eminence,  which  is  called 
OLorujs  MINOR  ; — while  the  part  at  wfiich  the  epididymis  ter- 
minates, is  called  the  G-LORUS  MAJOR.  We  should  now  put 
the  body  of  the  testicle  into  water,  and  then,  by  cutting 
through  the  tunica  albuginea,  we  shall  see  that  the  gland  is 
composed  of  a  mass, — which,  though  apparently  fibrous,  may 
be  proved,  by  a  successful  injection,  to  be  composed  of  tubes. 
These  tubuli  are  divided  into  sets,  by  portions  of  cellular 
membrane,  which  are  called  sepimenta.  We  may  now  tract ; 
the  parts  of  the  seminal  duct,  from  the  TUBULI  to  the  vas  de- 
ferens :  by  raising  the  coats  towards  the  epididymis,  we  may, 
perhaps,  seethe  vessels  called  VASA RECTA,  which  pass  from 
each  bundle  of  the  tubuli,  to  form  the  intricate  plexus  called 
RETE  TEST-IS, — and  which  is,  continued  towards  the  globus 


94 

ninjor,  and  gives  off,  within  the  cellular  membrane  covering 
it,  the  vessels  which  are  called  VAS A  EFFKRKNTIA,  OR  VASCU- 
LAR CONES.  The  union  of  these  vessels  may  be  considered 
as  the  beginning- of  the  epididymis  ;  wh:ch  may  now  be  tra- 
ced backwards  to  the  globus  minor,  as  a  duct  very  much  con- 
voluted. As  it  rises  from  the  globus  minor,  it  is  called  the 
VAS  DEFERENS, — which  name  it  retains,  until  it  terminates  in 
the  urethra.  We  very  frequently  find  a  vessel  called  VAS 
ABKKRANS,  passing  oft'  from  the  vas  deferens,  and  termina- 
ting in  a  culde  sac. 

The  name  of  CORPUS  HIGHMORIANUM  is  given  to  the  part 
of  the  testicle  where  the  vasa  recta  unite  to  the  rete  testis. 


1  shall  now  describe  the  manner  of  making  a  few  prepara- 
tions of  the  viscera  of  the  pelvis,  that  may  be  useful  to  the 
surgeon  ; — some  of  them  may  be  made  from  the  same  body 
in  which  the  parts  in  the  perineum  have  been  examined. 

If,  after  dissecting  the  muscles,  we  saw  through  the  raini 
of  the  pubes  and  isehium,  below  the  part  where  the  cura  pe- 
nis arise, — and  then  detach  the  bladder,  &c.  with  the  rec- 
tum, from  their  connections  with  the  posterior  and  lower 
part  of  the  pelvis, — we  may  remove  the  whole  of  the  viscera 
in  connection  with  the  os  pubis.  By  a  little  care,  we  may 
also  keep  the  testicles  attached  to  the  bladder,  through  the 
medium  of  the  vasa  deierentia.  The  bladder  is  then  to  be 
emptied,  and  the  vesiculae  and  prostate  are  to  be  squeezed, 
so  that  all  their  secretions  shall  be  pressed  out.  The  lower 
part  of  each  crus  of  the  penis  is  to  be  opened  ; — a  small  pipe 
is  to  be  fixed  into  one  of  them,  through  which  a  quantity  of 
warm  water  is  to  be  injected.  The  water,  passing  through  the 
cellular  structure,  and  septum  pectiniforme  of  the  cavernous 
body,  will  carry  the  blood  with  it,  and  escape  by  the  hole 
which  has  been  made  in  the  other  crus.  A  probe  is  to  be 
passed  along  the  vena  dorsalis  penis,  towards  the  glans,  so 
as  to  break  down  all  the  valves;  and  a  pipe  is  then  to  be  fix- 
ed  into  the  vein,  by  which  warm  water  is  to  be  injected,  so, 
H.S  to  wash  the  blood  out  of  the  spongy  body.  It  has  gene- 
rally been  supposed,  that,  to  distend  the  spongy  body,  it  will 
be  sufficient  to  inject  from  this  vein;  but  I  have  seldom  seen 
a  good  preparation  made  in  this  way.  I  have  always  found 
it  safer  to  make  another  opening  into  the  back  part  of  the 
irlans,  of  sulHcient  size  to  admit  a  small  pipe  ;  so  that,  if  the 
injection  from  the  vein  does  not  succeed,  the  glans  and  spon- 
gy body  may  be  easily  filled  from  this  opening.  After  the 
•H  vernous  and  spongy  bodies  have  been  completely  freed  of 


95 

the  blood  and  water,  by  being-  Repeatedly  squeezed,  they  arp 
in  a  fit  state  to  be  injected  ;  but  previous  to  injecting  them, 
a  long  iron  sound  should  be  passed  into  the  bladd  er  :  which 
will,  in  some  degree,  preserve  the  parts  in  their  natural  posi- 
tion.  The  white  cold  injection,  or  the  plaster  of  Paris,  may 
be  injected  into  the  cavernous  body,  by  the  pipe  in  its  cms  ; 
an  assistant  being  prepared  with  a  twisted  suture,  to  close 
the  opening  in  the  other  cms  as  soon  as  he  perceives  that 
all  the  blood  and  water  have  been  pushed  out  by  the  injec- 
tion. When  the  cavernous  body  is  sufficiently  filled,  the  cold 
red  injection  is  to  be  thrown  into  the  vein  on  thedorsum  of  the 
penis.  The  asssistant  must  be  very  active  in  pushing  the  in- 
jection along  the  spongy  body  :  but,  as  he  will  seldom  suc- 
ceed in  filling  the  bulb  from  this  source,  we  should  be  prepa- 
red to  inject,  also,  through  the  pipe  in  the  glans. 

As  soon  as  the  injection  in  the  penis  has  become  hard,  the 
bladder  should  be  filled  with  plaster  of  Paris;  but  as  the 
plaster  would  spoil  a  common  syringe,  we  should  make  an 
apparatus  for  the  purpose  :  this  is  easily  done  by  tying  a  stop 
c ock  to  an  ox's  bladder,  into  which  an  opening  has  been 
made  in  the  fundus,  so  that  a  quantity  of  plaster  may  be  put 
into  it.  The  stop-cock  b^ing  then  passed  into  a  pipe  which 
has  been  previously  fixed  in  the  ureter,  the  plaster  may  be 
pushed  on  so  as  to  fill  the  bladder. 

The  vesiculae  seminales  may  now  be  filled  with  mercury, 
by  making  an  opening  into  each  vas  deferens,  as  it  passes 
over  the  fundus  of  the  bladder.  We  may  also  try  to  inject 
the  testicles,  by  throwing  the  quicksilver  in  the  opposite  di- 
rection. The  parts  require  very  little  dissection  ;  but  it  is 
necessary  to  watch  them  carefully  while  they  are  drying,  so 
that  they  shall  keep  their  natural  position.  After  they  have 
been  thoroughly  dried,  they  must  be  well  varnished. 

It  will  be  very  useful  to  have  a  wax  model,  or  cast,  of  tlif 
\irethra  and  bladder,  in  their  natural  situation.  For  this  pur- 
pose, we  should  choose  a  subject  in  which  the  bladder  is  very 
much  contracted.  After  the  parts  have  been  removed,  with 
a  small  portion  of  the  bone,  in  the  same  manner  as  the  last 
preparation,  and  a  rough  dissection  of  the  penis  and  bladder 
has  been  made, — some  very  hard  and  tough  wax  injection 
should  be  thrown  into  the  urethra,  by  the  opening  in  the 
glans, — and.  into  the  bladder,  by  th'e  ureters.  When  the  in- 
j'^ction  is  cold>  the  bladder  is  to  be  opened,  so  that  we  may 
remove  the  cast. 

If  the  cavernous  and  spongy  bodies  have  been  previously 
well  cleaned,  we  may  put  the  penis  and  bladder  into  a  strong 
aluminous  spirit  before  cutting  out  the  cast,  so  that  when  the 
cast  is  removed,  the  urethra  and  bladder  shall  preserve  their 


96 

natural  shape.  But  to  make  a  good  preparation  of  this  kind, 
we  should  not  take  a  cast  at  the  same  time;  because  the  in- 
jection is  not  only  liable  to  discolour  the  internal  coat  of  the 
bladder,  but  the  process  of  injecting  will  probably  hurt  the 
appearance  of  the  parts,  for  the  beauty  of  such  a  preparation 
will  depend  very  much  on  its  being  cleanly  and  carefully  ma- 
cerated. 

When  the  parts  have  been  sufficiently  macerated,  some 
strong  aluminous  spirit  is  to  be  thrown  into  the  cavernous  and 
spongy  bodies  ;  the  urethra  and  bladder  are  also  to  be  filled 
with  the  same  fluid.  The  parts  are  then  to  be  put,  as  nearly 
as  possible  in  their  natural  relation  to  each  other,  into  a  glass 
jar  full  of  spirits,  and  to  remain  in  it  until  they  are  sufficiently 
hardened.  The  preparation  is  then  to  be  taken  out  of  the 
jar,  and  the  external  parts  of  the  penis  and  bladder  are  to  be 
more  neatly  dissected ;  the  lateral  part  of  the  urethra  and 
bladder  is  then  to  be  opened,  so  as  to  give  a  distinct  view  of 
the  course  of  the  canal ;  bristles  should  be  put  into  the  seve- 
ral ducts.  This  preparation,  though  it  may  not  give  a 
very  accurate  idea  of  the  size  of  the  canal,  will  yet  be  very 
valuable,  and  should  be  put  up  neatly  in  a  jar  of  spirits. 

I  may  here  observe,  that  when  we  wish  to  preserve  the 
bladder,  &c.  either  in  their  natural  or  morbid  state,  that  we 
should  attend  to  the  following  general  rules :  1st.  previous  to 
putting  the  part  into  maceration,  we  should  dissect  off  all  the 
muscles,  &c.  which  we  do  not  intend  to  preserve  ;  2d.  free 
the  cavernous  and  spongy  bodies,  of  blood,  by  repeatedly  in- 
jecting them  with  water ;  3d.  empty  the  vesiculce  and  the 
prostate  by  gently  squeezing  them ;  4th.  before  the  part  is 
put  into  the  macerating  pot,  we  should  fill  the  bladder  and 
the  cavernous  and  spongy  bodies  with  clean  water  ;  lastly, 
the  preparation  should  be  suspended  near  the  top  of  the  jarr 
and  the  water  changed  twice  a  day. 

A  preparation  of  a  diseased  penis  and  bladder  may  be  re- 
moved, without  even  opening  the  body ;  for  if  we  make  a  long 
cut  in  the  perineum,  we  may  dissect  the  penis  from  the  rami 
and  arch  of  the  pubes ;  and  then  by  passing  a  knife,  directed  by 
the  ringer,  into  the  pelvis,  we  may  carry  it  round  the  bladder, 
so  as  to  separate  it  from  its  connections  internally ;  and  then 
by  cutting  the  body  of  the  penis  across,  all  the  parts  may  be 
easily  pulled  out.  But  if  \ve  are  desirous  of  preserving  the 
whole  of  the  body  of  the  penis,  we  ought  to  cut  the  attachment 
of  the  prepuce  to  the  corona  glandis,  and  then  by  pulling  the 
penis  from  below,  it  will  be  easily  separated  from  the  loose 
skin.  If  the  penis  has  been  cut  through,  below  the  scrotum. 
it  will  be  only  necessary  to  sew  up  the  cut  in  the  perineum  ; 
hut  if  the  whole  has  been  removed,  then  we  must  stuff  tlie 


97 

skin  of  the  penis  with  tow, — having-  first  passed  a  fine  thread 
through  the  inside  of  the  prepuce,  so  as  to  give  it  the  ap- 
pearance of  a  phymosis. 

When  we  cut  out  a  fine  example  of  stricture,  &c.  we 
should  always  endeavour  to  take  a  os  pubis  with  the  bladder. 
It  is  rather  difficult  to  do  this,  unless  we  are  at  the  samp 
time  permitted  to  open  the  abdomen^  b*it  an  expert  dissec- 
tor will  be  able  to  effect  it,  by  makir^p.  large  incision  below. 
Whenever  a  portion  of  bone  is  removed,  before  the  parts  art- 
sewed  up,  a  strong  cord  should  be  passed  through  the  obtu- 
rator holes,  so  as  to  hold  the  two  sides  of  the  pelvis  togeth- 
er ;  for  if  this  is  not  done,  the  body  will  appear  very  much 
disfigured. 


DISSECTION 

Of  THE 

PARTS   IN  THE  PELVIS 

OF  THE  FEMALE. 


Although  the  dissection  of  the  parts  in  the  female  pernm 
amis  not  Very  interesting,  in  a  surgical  view,  still  it  is  nece?- 
*ury  to  make  it  ;  and  at  the  same  time  to  attend  to  the  names 
which  have  been  given  to  the  several  parts. 

The  Mons  Veneris  will  be  found  to  be  only  an  accumula- 
tion of  adipose  substance  under  the  integuments,  and  which 
varies  in  size  according  to  the  general  state  of  the  individual. 
The  cavity  which  begins,  as  a  fissure,  under  the  mons  vene~ 
ris,  and  extends  to  within  an  inch  of  the  anus,  is  called  vut- 
iw,  being  the  name  given  to  the  opening  of  the  vagina  and 
urethra  generally.  The  thick  folds  of  integument  which  are 
continued  down  from  the  lateral  parts  of  the  mons  veneris, 
are  the  Labia  Externa,  or  Alee  Majores  ;  their  union,  at  the 
lower  part  of  the  vulva,  being  called  the  Frcenttm  Labiorvm. 
or  Fourchette :  the  kittle  cavity  above  this  angle  of  union* 
is  sometimes  called  Fossa  Navicufaris.  The  skin  which  is 
between  the  Fourchette  and  anus,  is  called  the  Anterior  P? 
rineum ;  while  the  part  between  the  anus  and  os  coccygi.*  ,-;<••• 
the  posterior. 


98 

If  we  separate  the  labia,  we  shall  see,  immediately  under 
the  mons  veneris,  a  little  projecting  red  body,  with  some  loose 
skin  covering-  it ;  this  is  the  G/Vw.s>  and  Prepuce  of  the  Clitoris. 
The  two  thin  folds  of  membrane  which  may  be  traced  down- 
wards from,  the  prepuce,  are  the  Nympha*  or,  or  Alee  Mhwres, 
between  which,  and  about  three  quarters  of  an  inch  below 
the  clitoris,  we  shall  discover  the  prominent  opening  of  the 
urethra.  The  upper  part  of  the  vulva  is  called  the  Vest'ibu- 
him ;  and  below  the  level  of  the  urethra,  it  is  called  Orijici>-m 
f^agince,  which,  in  the  virgin,  is  bounded  by  two  folds  of  mem- 
brane, that  nearly  meet  in  the  middle,  and  form  the  part  cal- 
led Hymen  :  when,  this  is  ruptured,  there  are  little  fleshy  emi- 
nences seen  on  the  laterol  parts  of  the  vagina,  which  are  ge- 
nerally supposed  to  be  the  remains  of  the  hymen,  and  are  cal- 
led Cariinculce  <Myrtiformes. 

As  the  dissection  of  the  muscles  here,  is  not  of  much  im- 
portance to  the  student,  I  shall  give  only  a  table  of  their  ori- 
gins and  insertions. 

The  muscles  of  the  female  perineum,  are — 

ERECTOR  CLITORDIS.  OR.  Prom  the  cms  of  the  os  is'  hi- 
um  internally  :  in  its  ascent  it  covers  the  cms  of  the  clitoris, 
as  far  up*as  the  os  pubis. 

IN.  Into  the  upper  part  of  the  cms, — and  body  of  the  clitoris. 

USE.  To  erect  the  clitoris,  by  pushing  the  blood  into  its 
cavernous  substance. 

SPHINCTER  VAGINJE.  OR*  From  the  sphinter  ani,  and 
from  the  posterior  side  of  the  vagina,  near  the  perineum  ; 
from  thence  it  runs  up  the  side  of  the  vagina,  near  its  exter- 
nal orifice,  opposite  to  the  nymphae,  and  covers  the  corpus 
cavernosum  vaginae. 

IN.  Into  the  body,  or  union  of  the  crura  clitoridis. 

USE.  Contracts  the  mcuth  of  the  vagina,  arid  by  compres- 
sing the  corpus  cav.ernosum,  pushes  the  blood  into  the  clito-, 
ris  and  nymphae. 

TRANSVERSALIS  PERINEI.  OR.  As  in  the  male,  from  the 
fatty  cellular  membrane  which  covers  the  tuberosity  of  the 
os  ischium. 

IN.  The  upper  part  of  the  sphincter  ani, — and  into  a  white 
tough  substance  in  the  perineum,  between  the  lower  part  of 
the  pudendum' and  anus. 

USE.  To  sustain  the  perineum. 

SPHINCTER  ANI.  OR.  As  in  the  malf,  from  the  skin  and 
fat  surrounding  the  extremity  of  the  rectum. 

IN.  Into  the  white  tough  substance  in  the  perinea *rr; — and 
"below,  into  the  front  of  the  os  oceygis*. 


99 

LI.VATOR  ANI.  On.  As  in  the  rnale>  within  the  pelvis.    It 
descends  along  the  inferior  part  of  the  vagina  and  rectum. 
L\.  Into  the  perineum  and  sphincter  ani. 

After  having-  dissected  the  muscles,  we'may  remove  them,' 
so  as  to  expose  the  Crura  of  the  Clitoris, — which  are  attach- 
ed to  the  rami  of  the  os  pubis,  nearly  in  the  same  manner  as 
the  crura  of  the  corpus  cavernosuiu  are,  in  the  male;  by 
opening  one  cms  we  may  distend  the  clitoris  We  shall  find 
no  spongy  body  in  the  clitoris;  but  there  is  something  analo- 
gous to  if,  surrounding  the  oritice  of  the  vagina  ;  it  is  called 
Rfitfi  ra&culosum,  or  Pl.e-.cus  ReUformis, — or  sometimes,  Cor- 
pus Cavernosum  Vagince. 

The  parts  within  the  pelvis  should  be  examined,  before  a. 
perpendicular  section  is  made.  The  peritoneum  has  been 
already  described  as  passing  from  the  rectum  to  the  uterus, 
an  1  from  the  uterus  to  the  bladder.  If  we  pull  up  the  uterus 
from  between  the  bladder  and  rectum,  we  shall  see  the  folds 
of  the  peritoneum  which  form  the  Bro'td  Ligaments  of  the 
uterus  ;  between  the  duplicatures  of  which,  we  may  feel  the 
Round  Ligament*  which  pass  to  the  abdominal  rings.  The 
oo  triit  will  be  seen  in  the  broad  part  of  the  ligament;  and 
anterior  to  them,  the  Fallopian  TI&PS,  each  of  which  has  a 
floating  fringed  extremity,  called  the  •W>r*u*  Diaboli.  These 
parts  are  very  seldom  found  in  a  natural  state, — for  the  uterus 
and  its  appendages  are  so  prone  to  inflammation,  that  there 
aro  generally  adhesions  between  them  :  there  are  also  very 
frequently,  small  tumours  or  hydatids  attached  to  the  ova-  , 
rium. 

The  section  of  the  pelvis  is  to  be  made  nearly  in  the  same 
m.imier  as  it  is  directed  to  be  made  in  the  male.  The  struc- 
ture and  form  of  the  clitoris,  the  course  of  the  urethra  and 
of  the  vagina,  willbe  all  now  easily  understood.  If  we  lay 
open  the  vagina,  we  shall  see  the  part  of  the  uterus  which  is 
called  the  O;  Lin'-(K ;  the  portiofi  to  which  the  vagina  is  attach- 
ed, being  called  the  C^nix'.  Upon  the  internal  fine  secreting 
mvnbranae  of  the  vagina,  many  mucous  folicles,  or  lacuna?, 
will  be  seen.- 

Tho  urethra  is  very  short,  and  very  simple  in  its  structure, 
compared  with  that  of  the  male.  We  cannot  discover  any 
glands  in  it,  similar  to  those  which  are  connected  with  the 
neck  of  the  bladder  in  the  male  ;  but  on  opening  the  ure- 
thra, we  shall  see  several  lacume.  The  internal  membrane 
H  not  muscular,  but  has  many  longitudinal  folds,  which  per- 
mit of  its  being  dilated  to  a  great  extent. 
•  Tii"4  uterus  and  ovaria  may  now  be  dissected  from  the  oth- 
er ,>arf>.  When  the  cellular  membrane  is  removed  from  the 


100 

uterus,  we  can  comprehend  how  the  nam.es  of  Cervix,  Bod)/. 
and  Fundus,  have  been  given  to  its  several  parts.  When  tlit 
uterus  iks  opened,  we'shall  see  that  it  has,  internally,  a  fleecy 
secreting*  surface;  and  on  each  side  of  the  upper  part  of  the 
cavity,  we  shall  discover  an  opening,  by  which  we  may  pass 
bristles  into  the  Fallopian  tubes.  If  we  make  a  section  of 
the  ovarium  of  a  young-  person,  several  small  transparent  ves- 
icles, which  are  supposed  to  be  the  Ova,  will  be  seen  ;  they 
are  often  called  Curytora  Graajlana.  In  an  older  person,  and 
particularly  in  one  who  has  been  pregnant,  small  cysts  are 
generally  found  in  the  ovarium ;  they  are  supposed  to  corres- 
pond to  the  number  of  ova  which  have  escaped.  Immedi- 
ately after  conception  there  is  a  cyst  of  a  yellow  colour, — 
whence  it  has  been  called  Corpus  Liiieum. 

The  vessels  in  the  pelvis  of  the-  female  differ  considerably 
from  those  in  the  male, — principally  in  there  being  four  ad- 
ditional arteries  of  importance,  viz.  the  two  Spermatic 
Arteries,  which  run  to  the  ovaria  arid  to  the  fundus,  and 
•to  the  body  of  the  uterus;  and  the  two  Uterine  Arteries,  which 
arise  from  the  internal  iliacs,  and  pass  to  the  lower  part  of 
the  uterus,  and  inosculate  freely  with  the  spermatic  arteries. 
Kach  of  these  vessels  has  a  corresponding  vein- 

The  arteries  to  the  external  parts,  nearly  correspond  with 
those  in  the  male. 

The  JVerveswill  be  described  with  those  of  the  Abdomen, 


DISSECTION 


THE  THIGH. 


THE  object  of  the  student,  in  his  first  dissect  ion  of  tin 
?!.£h,  should  be  to  acquire  a  general  idea  of  the  connections 
»f  the  muscles  and  of  the  ligaments.  In  his  second  dissec- 
tion, he  should  trace  the  injected  arteries:  and  in  the  third, 
the  nerves,  with  the  arteries  uninjected  ;  he  will  then  IK- 
prepared  to  study  the  parts  in  connection,  so  as  to  makf 
himself  master  of  the  surgical  anatomy  of  the  lower  c> 
mitv. 


101 

I  shall  now  endeavour  to  describe  the  best  method  of  con- 
ducting* the  investigation  of  the  anatomy  of  the  thigh  and 
leg  in  this  order. 

FIRST  DISSECTION. 

The  fascia  which  covers  the  muscles  should  be  exposed, 
before  they  are  dissected:  but  some  care  is  requisite  to  do 
this  neatly,  as  the  fascia  is  very  thin  at  certain  points.  In- 
deed, it  is  so  thin  on  the  fore  and  inner  part  of  the  thigh, 
that  if  the  dissection  is  commenced  at  this  point,  it  will  be 
very  difficult  to  avoid  cutting  the  fascia.  The  leg  ought, 
therefore,  to  be  thrown  over  the  other,  so  that  an  incision 
may  be  made  through  the  skin,  from  the  point  over  the  tro- 
elmnter  major,  where  the  fascia  is  strong,  to  the  head  of 
the  fibula.  The  skin  is  then  to  be  separated  from  the  fascia, 
by  carrying  the  edge  of  the  knife  in  a  slanting  direction. 
After  a  little  of  the  fascia  has  been  exposed  through  the 
whole  extent  of  the  incision,  a  cut  is  to  be  made  through  the 
skin  only,  across  the  lower  part  of  the  patella,  and  another 
from  the  trochanter  to  the  pubes.  The  dissection  is  then  to 
be  continued,  by  raising  the  skin  very  carefully  towards  the 
fore  and  inner  part  of  the  thigh.  If  any  muscular  fibres  be 
exposed,  the  dissector  may  be  sure  that  he  is  doing  wrong ; 
and  if  he  looks  at  the  inner  surface  of  the  skin,  he  will  prob- 
ably see  a  portion  of  the  fascia  adhering  to  it.  As  the  fas- 
cia is  very  strong  on  the  back  part  of  the  thigh,  it  will  be 
very  easily  exposed  there :  but  I  may  here  remark,  that  it 
will  be  more  difficult  to  make  a  good  exhibition  of  the  fascia 
in  a  strong  and  fat  subject,  than  in  a  thin  one. 

After  the  skin  is  removed,  we  shall  be  able  to  see  the 
muscles  which  are  immediately  under  the  fascia.  The  first 
muscle  that  will  catch  our  eye  is  the  Sartorius,  the  fibres 
of  which  should  be  now  exposed  by  carrying  the  knife  in  the 
direction  of  them,  from  the  ilium  to  the  tibia.  The  muscle 
which  is  crossed  by  the  sartorius,  and  runs  down  directly  in 
the  middle  of  the  thigh,  is  the  Rectus;  but  before  we  dissect, 
this,  or  the  Vastus  Exturnus,  which  is  situated  externally 
to  the  rectus,  we  should  expose  the  fleshy  part  of  the  Ten- 
sor Vaginae,  Femoris,  or  Faadnlis^  and  then  cut  a  slip  of  the 
fascia  as  far  as  to  the  fibula,  so  that  it  may  be  as  a  tendon  to 
this  muscle  :  the  rest  of  the  fascia  may  be  then  cut  away, 
by  which  we  shall  be  enabled  to  expose  more  easily,  the 
fibres  of  the  rectus  and  vastus  externus.  It  is  difficult  to 
dissect  this  last  muscle  neatly,  on  account  of  the  firm  con- 
nection which  the  cellular  membrane  has  with  its  lower 
semicircular  fibres. 

I  2 


102 

We  may  now  dissect  the  muscles  which  are  on  the  insi:!*- 
of  the  thigh.  But  hefore  beginning,  we  should  separate 
the  thighs  a  little,  by  which  the  thin  muscle  (the  GraciHs} 
Miat  passes  from  the  pubes  to  the  leg  will  be  more  easily  dis- 
sected. Upon  the  inside  of  the  gracilis,  we  shall  see  a  mass 
of  muscles  passing  from  the  pubes  to  the  linea  aspera ;  this 
is  principally  composed  of  the  three  which  form  the  Triceps 
or  Adductor.  To  dissect  the  first  of  these, — the  Adduc- 
tor Longus,  we  have  only  to  follow  its  fibres  from  the 
pubes  to  the  linea  aspera;  but  in  doing  this,  we  shall  be 
obliged  to  cut  through  the  great  vessels,  nerves,  &c.  which 
are  passing  from  the  pelvis  to  the  leg  ;  this,  however,  ought 
to  be  considered  of  no  consequence  ;  for  in  the  first  dissec- 
tion, every  thing  should  be  sacrificed  to  the  muscles.  If  we 
continue  the  dissection  towards  the  union  of  the  os  pubis 
and  ilium,  we  shall  expose  the  fibres  of  the  muscle  called 
Pectinalis.  In  tracing  it  down  to  its  insertion,  we  shall  be 
obliged  to  remove  a  number  of  vessels,  glands,  &c.  by  which 
we  shall  expose  the  insertion  of  the  Psocts  Magnus  and  Ilia- 
•'lift  Internus  into  the  trochanter  minor.  By  dissecting  be- 
tween tine  pectinalis  and  adductor  longus,  we  shall  discover 
the  Addiwtor  Brevis,  which  has  very  nearly  the  same  form 
as  the  pectinalis.  After  this,  we  may  dissect  part  of  the  Ad- 
ductor Magnus ;  but  before  we  can  expose  all  the  fibres 
of  this  muscle,  we  must  turn  the  leg :  however,  this  is  riot 
to  be  done. yet,  for  while  the  leg  is  in  the  present  position, 
we  should  dissect  the  Vasius  Internus,  which  arises  from 
the  greater  extent  of  the  thigh  bone,  and  is  inserted  into  the 
patella.  When  the 'dissection  of  this  muscle  is  finished,  the 
rectus  may  be  raised  and  held  aside,  so  that  the  Cruraeu-s, 
which  is  between  the  vasti,  may  be  seen.  It  is  difficult  to 
separate  the  vasti  neatly  from  the  crurams ;  for  the  only 
guide  which  we  have,  is  a  few  vessels  which  pass  between 
the  muscles. 

After  having  made  the  origins  and  insertions  of  these 
muscles  distinct,  (for  which  see  the  annexed  table,)  the  leg 
should  be  turned,  and  the  muscles  on  the  back  part  dissected. 

The  first  muscle  which  is  to  be  dissected  is  the  Glutens 
Mi-ximus.  Before  commencing,  we  should  endeavour  to 
make  its  fibres  tense,  by  putting  a  block  under  the  pelvis, 
and  throwing  the  leg  over  the  table  and  fixing  it  there,  with 
the  toes  turned  inwards.  An  incision  is  then  to  be  made 
round  the  spine  of  the  ilium,  and  another  from  the  middle  of 
the  spine  or  the  sacrum  to  opposite  the  trochanter  major, — 
this  last  incision  should  be  slightly  semicircular,  with  its  con- 
cavity towards  the  anus.  As  there  is  no  fascia  covering 
this  muscle,  the  fibres  will  now  be  seen,  and  may  be  fully 


103 

exposed  by  cutting  boldly  in  the  whole  extent  of  the  line  of 
the  semicircular  cut,  first  in  a  direction  towards  the  anus, 
and  then  towards  the  ilium.  We,  shall  find  that  the  muscle 
does  not  arise  from  the  whole  extent  of  the  spine  of  the 
ilium,  but  that  part  of  the  spine  is  occupied  by  a  portion  of 
the  Glutens  Medvus,  which  is  covered  by  a  strong  fascia.  This 
fascia,  which  runs  between  the  two  muscles  (and  is  united  to 
the  fascia  lata,)  is  now  to  be  divided,  from  the  spine  of  the 
ilium  to  near  the  trochanter.  By  then  cutting  through  the 
origin  of  the  glutous  maximus,  from  the  iliurn  and  sacrum,  it 
may  be  easily  separated  from  the  medius,  and  thrown  down 
upon  the  thigh,  leaving  it  attached,  by  its"  insertion,  to  the 
linea  aspera ;  and  in  doing  this,  we  should  raise  as  much  of 
the  cellular  membrane  as  we  can,  along  with  the  muscle.  If 
this  has  been  done  carefully,  it  will  now  be  only  neces- 
sary to  dissect  off  the  fascia  from  the  upper  and  outer  part  of 
the  gluteus  medius,  to  make  it  distinct.  When  we  wish  to 
raise  the  gluteus  medius,  we  should  commence  at  the  notch 
of  the  ilium,  and  remove  the  fibres  from  the  dorsum  of  the 
ilium,  as  far  as  the  anterior  spinous  process,— by  commencing 
at  the  notch  we  shall  not  endanger  the  Gluteus  J\Iinimus  so 
much  as  we  should,  if  we  wrere  to  begin  the  separation  at 
the  upper  and  outer  part.  When  the  muscle  is  thrown  down 
to  its  insertion,  the  Gluteus  Minimus,  Pyriformis,  (part  of 
which  might  be  seen  before  the  medius  was  lifted,)  Gemcllus 
Superior,  Obturator  Intemus,  Gemellus  Inferior,  and  Quad- 
ratus  Femoris,  will  be  all  partially  seen. 

Before  we  can  dissect  these  small  muscles,  we  must  turn 
the  heel  out,  by  which  we  shall  stretch  their  fibres,  which 
arise  from  the  pelvis,  and  are  inserted  into  the  head  of  the 
femur.  The  great  nerve  which  crosses  the  small  muscles 
may  be  cut  across ;  or  by  bending  the  knee,  it  will  be  relax- 
ed, so  that  it  may  be  held  aside.  I  may  also  remark,  that  it 
will  be  necessary  to  turn  to  the  inside  of  the  pelvis,  before 
the  obturator  internus  aD'l  pyriformis  can  be  completely  dis- 
sected :  and  that  before  the  tendon  of  the  Obturator  Extermm 
can  be  seen,  the  quadratus  femoris  must  be  raised.  To  show 
the  whole  of  the  obturator,  it  will  be  necessary  to  remove 
the  muscles  which  lie  on  the  fore  part ;  but  this  should  not 
be  done,  until  all  the  other  muscles  are  fully  examined.  Be- 
fore the  muscles  on  the  back  of  the  thigh  are  exposed,  the 
student  should  refer  to  the  table  of  origins  and  insertion^, 
for  a  description  of  the  muscles  which  he  has  just  dissected. 

The  limb  is  to  be  then  extended,  and  laid  on  its  fore  part. 
The  dissection  should  be  begun  on  the  inner  part,  by  dis- 
secting behind  the  gracilis,  by  which  we  shall  come  upon  the 
Semitendinoeus  that  runs  from  the  ischiumto  the  inside4of  the 


104 

tibia ;  between  it  and  the  gracilis,  we  shall  find  some  fibres 
of  the  adductor  inagnus;  these,  however,  at  present,  we 
should  neglect.  In  dissecting  the  origin  of  the  semitendino- 
sus,  we  shall  discover  the  origin  of  another  muscle  which 
passes  towards  the  outer  part  of  the  leg  ;  and  if  we  follow  it, 
we  shall  find  that  it  is  united  with  a  set  of  fibres  which  arise 
from  the  back  part  of  the  lineaaspera,  and  that  the  two  por- 
tions, when  united.,  pass  down  to  the  head  of  the  fibula; 
tliis  is  th  j  Biceps,  and  is  the  muscle  which  forms  the  outer 
ham-string.  Before  removing  the  fat  and  the  nerve  and  ar- 
tery which  are  in.  the  ham,  between  the  semitendinosus  and 
biceps,  we  should  dissect  the  muscle  that  arises  from  the 
ischium,  below  the  semitendinosus,  and  is  inserted  into  the 
head  of  the  tibia.  This  muscle  is  distinguished  from  the 
semitendinosus  by  the  name  of  Semimembranosus,  which  is 
given -to  it,  from  its  membranous  ^appearance.  These  two 
last  muscles  form  the  inner  ham-string. 

After  removing  all  the  vessels,  nerves,  &  c.  from  the  ham, 
the  back  part  of  the  adductor  magnus  maybe  easily  exposed 
through  its  whole  extent:  and  the  opening  in  it  through 
which  the  artery  passes  from  the  fore  part  of  the  thigh  into 
thoham,  will  be  also  seen. 

In  making  this  last  dissection,  we  shall  necessarily  expose 
the  origins  of  the  GaMrocnemius;  but  the  muscles  of  the  leg 
should  not  be  traced,  until  we  have  made  ourselves  com- 
pletely master  of  the  anatomy  of  the  muscles  of  the  thigh, — 
nor  should  the  skin  be  raised,  for  as  long  as  the  muscles  are 
covered  by  the  skin,  they  will  keep  fresh. 

The  dissection  of  the  muscles  of  the  leg  is  to  be  begun  by 
making  an  incision  from  below  the  patella,  along  the  spine  of 
the  tibia,  to  the  great  toe,  and  another  along  the  middle  of 
the  back  of  the  leg,  from  the  knee  to  the  heel ; — the  skin 
only,  is  then  to  be  removed.  This  will  expose  a  fascia, 
which,  though  very  strong  on  the  fore  part  of  the  leg,  be- 
<•<  ines  still  so  much  stronger  at  the  ankle,  in  consequence  of 
additional  cross  slips  of  fascia,  that  it  is  there  described  as 
forming  particular  ligaments,  winch  are  called  Annular  Liga- 
rntnts.  The  fascia  upon  the  fore  part  of  the  foot  is  very  thin, 
being  little  more  than  cellular  membrane. 

When  the  skin  is  taken  off  from  the  back  part,  very  little 
fascia  will  be  seen  covering  the  large  muscle,  the  gastrocne- 
mius ;  but  by  continuing  the  incision  from  the  heel  along  the 
sole  of  the  foot,  we  shall  discover  a  very  strong  fascia,  which 
is  called  the  Plantar  Jlponeurosis.  To  dissect  this  neatly, 
we  should  pull  the  thick  skin  of  the  foot  forcibly  to  each  side, 
and  carry  the  knife,  in  a  slanting  direction,  close  upon  the 
fascia. 


105 

We  may  now  proceed  to  dissect  the  muscles.  The  exter- 
nal muscle  of  the  calf,  the  Gastrocnemius ,  is  very  easily. 
shown,  for  we  have  only  to  carry  the  knife  in  the  direction  of 
its  fibres.  In  dissecting  this,  the  edge  of  the  next  muscle, 
the  soleus,  will  be  exposed :  but  before  it  can  be  fairly  seen, 
the  origin  of  the  gastrocnemius  from  the  internal  condyle. 
must  be  raised,  and  then  we  shall  also  see  the  small  muscle 
(Plantaris)  which  arises  in  union  with  its  external  origin, 
and  runs  down  to  the  inside  of  the  os  calcis.  In  this  view, 
the  Popliteus,  which  arises  from  the  lower  part  of  the  exter- 
nal condyle,  and  runs  to  the  tibia,  will  also  be  exposed. 

To  show  the  tendo  Achillis,  which  is  formed  by  the 
Gastrocnemius^  Soleus,  and  Plantaris ,  we  must  remove  a 
large  quantity  of  fat,  which  is  situated  between  it  and  the 
next  layer  of  muscles.  The  soleus  may  then  be  raised  from 
its  origins,  from  the  tibia  and  fibula,  and  turned  down  with 
the  gastrocnemius  and  plantaris,  to  their  attachment  to  the 
os  calcis.  This  will  enable  us  to  see  the  deep  layer  of 
muscles,  which  are  covered  by  a  strong  fascia;  but  it  will 
not  be  possible  to  trace  these  muscles  to  their  insertions,  un- 
til those  of  the  foot  are  dissected.  By  cutting  away  the 
fascia,  and  all  the  vessels  and  nerves,  with  their  surrounding 
cellular  membrane,  the  origins  of  these  muscles  will  be 
seen,  viz.  of  the  Flexor  Pollicis  Longus,  principally  from 
the  fibula — the  Fexor  Longus  Digitorum,  from  the  tibia — and, 
between  the  two,  the  Libialis  Posticu^^  which  has  an  ex- 
tensive origin  from  both  bones.  Each  of  these  muscles 
passes  behind  the  inner  ankle,  and  is  bound  down  by  distinct 
annular  ligaments :  but  before  tracing  them  farther,  we  must 
dissect  the  muscles  on  the  fore  part  of  the  leg. 

The  fascia  adheres  very  strongly  to  the  muscles  which 
arise  from  the  tibia,  and  particularly  to  the  Libialis  Jlnticus, 
so  that  it  is  rather  difficult  to  take  it  off  neatly.  In  removing 
it,  we  must  take  care  that  we  do  not  cut  through  the  annular 
ligaments  at  the  ankle.  If  we  trace  thq  tibialis  anticus,  we 
shall  find  it  pass  to  the  internal  cuneiform  bone.  The  muscle 
which  iies  close  upon  it,  and  arises  principally  from  the  fibula, 
is  the  Extensor  Communis  D-igitorum,  which  passes  to  all  the 
toes  except  the  great  toe.  The  separate  extensor  for  the 
great  toe  (Extensor  Pollicis  Proprius)  arises  between  the  two 
last  muscles.  Upon  the  outer  edge  of  the  extensor  commu- 
nis  digitorum,  there  are  three  muscles,  which,  as  they  rise 
from  the  fibula,  are  called  peronei :  the  first  is  called  Peroneus 
Longus,  and  may  be  traced  down,  under  the  outer  ankle,  as 
far  as  the  os  cuboides,  but  here  its  tendon  passes  into  a 
groove,  and  then  across  the  sole  of  the  foot,  to  the  cuneiforme 
internum :  this  will  be  seen  when  the  muscles  of  the  foot  are 


106 

dissected.  The  Peroneus  Secundus,  or  Brevis,  runs  in  the 
same  Khe  along-  the  fibula,  but  is  inserted  into  the  rnetatarsal 
bone  of  the  little  toe.  The  Peroneus  Tertins  is  generally  so 
much  connected  with  the  fleshy  part  of  the  extensor  commu- 
nis  digitorum,  that  it  is  difficult  to  separate  them  at  this  part ; 
we  should  therefore  first  dissect  its  tendon,  which  is  inserted 
into  the  metatarsal  bone  of  the  toe  next  the  little  toe. 

As  there  is  only  one  muscle  on  the  fore  part  of  the  foot, 
(the  Extensor  Brevis  Digitorum,]  there  can  be  no  difficulty  in 
dissecting  it ;  but  it  is  not  so  with  those  in  the  sole  of  the 
foot, — for  the  muscles  there,  are  not  only  particularly  com- 
plicated, but  the  difficulty  is  increased  in  consequence  of 
several  of  the  tendons  of  the  muscles  on  the  leg  running  be- 
tween them. 

The  plontar  fascia  is  to  be  first  cut  through,  about  the 
middle,  and  then  the  one  half  is  to  be  raised  towards  the 
heel,  and  the  other  towards  the  toes ;  but;  in  removing  it, 
we  must  carefully  avoid  lifting  the  origin  and  insertions  of 
the  Flexor  Digitorum  Brevis,  which  arises,  in  part,  from  the 
fascia.  After  this  muscle  is  dissected,  the  Abductor  Pollicu\ 
-and  Abductor  J\finimi  Digiti,  which  are  on  each  side  of  the 
foot,  are  to  be  exposed ;  then  the  flexor  digitorum  brevis  is 
to  be  cut  through  at  its  origin,  and  is  to  be  carried  towards 
the  toes ;  this  will  expose  the.  tendon  of  the  long  flexor,  to 
which  the  Flexor  Accessorius,  which  arises  from  the  os  calcis, 
is  attached.  From  the  fore  part  of  the  same  tendon,  the 
Lwnbricales  will  be  seen  passing  to  the  toes.  When  th-^e 
tendons  are  cut,  and  turned,  with  the  lumbricales,  towards 
the  toes,  the  tendons  of  the  tibialis  posticus,  and  of  the  pero- 
neus  longus,  will  be  seen  crossing  the  foot.  We  may  now 
easily  dissect  the  Flexor  Brevis  and  Adductor  Pollicis  on  the  out? 
side,  and  the  Flexor  and  Adductor  Minimi  Digiti  on  the  other. 
When  these  are  made  out,  there  will  only  remain  the  Trans- 
yersalis-  and  the  Interossei. 

It  will,  perhaps,  assist  us  in  recollecting  these  muscles,  if 
we  arrange  them  into  classes.  This  may  be  done  in  several 
ways,  but  to  all  of  which  there  are  many  objections.  The 
following  plan  is  offered,  although  it  is  also  very  faulty. 

To  pull  the  thigh  backwards,  there  are  three  muscles,  viz. 
.the  Glutens  Jftaximus,  Gluieus  JWedius,  and  Glutens  JWmimim^ 
which  have,  as  antagonist  muscles,  the  Psoas  JWagnvs  and 
Hi  item  Infernus. 

The  class  of  muscles  which  more  particularly  roll  the 
thigh,  is  composed  of  the  Pyriformis,  Gemellus  Superior 
Obturator  Internus,  Gemellus  Inferior,  O'jiurator  Extertu'*. 
and  Quadratus  Femo-ris. 


107 

CLASSIFICATION  OF  THE  MUSCLES  OF  Tlif 
THIGH,  LEG,  AND  FOOT. 

MUSCLES  OF  THE  THIGH. 

The  three  superficial  muscles,  Fascialis,  Sarlorhts>  and 
Gracifis,  may  be  classed  together. 

If  these  three  are  removed,  twelve  muscles  will  remain  on 
the  thigh ;  of  which  four  are  inserted  into  the  patella,  and 
extend  the  leg,  viz.  the  Redux,  J^astus  Externus,  Fastw  inter- 
WAV,  and  Crurceus.  Four  bend  the  leg,  and  are  inserted  into  the 
tibia  and  fibula,  viz.  Semite-ndincsus,  Scmimeinbrano&tis,  Biceps^ 
and  Popliteus.  And  four,  which  pull  the  thighs  together  (ad- 
ductors,) are  inserted  into  the  linea  aspera,  viz.- Pectinate,  Ad- 
ductor Longus,  Adductor  Brevis.,  arid  Adductor  J\lagnus. 

MUSCLES  OF  THE  LEG. 

As  the  muscles  which  bend  the  toes  are  situated  on  the 
back  part  of  the  leg,  and  those  which  bend  the  foot  are  on  ,- 
the  fore  part,  it  is  not  possible  to  make  a  good  arrangement 
according  to  the  uses  of  the  muscles ;  therefore,  in  the  fol- 
lowing plan,  the  use  of  the  muscles  is  entirely  neglected, 
the  arrangement  being  made  according  to  their  relative 
situations. 

There  are  twelve  muscles  on  the  leg,  which  may  be  di- 
vided into  two  great  classes,  viz.  into  six  on  the  fore  part, 
and  the  same  number  behind,— both  of  which  may  be  subdi- 
vided :  the  six  on  the  fore  part,  into  three  on  the  fibula,  viz, 
Peronefo  Z/ongits,  Peron-evs  Brevi^  and  Perorwu*  Tertiior— and 
three,  more  directly  on  the  fore  part,  Tibialis  Anticus,  Extensor 
DigitorurnCornmunix,  and  Extensor  Pollicis  Propri us ;  the  six 
on  the  back  part,  may  be  still  more  easily  subdivided  into  the 
three  which  are  inserted  into  the  os  calcis,  viz.  Gagtrocnemitts, 
soleu9)WQ&Ptartari$ — and  into  the  three  deep  muscles,  Tibia- 
Us  PosticitSy  Flexor  Digitorwn  Longus,  and  Flexor  PolliciK 
Longus. 

MUSCLES  OF  THE  FOOT. 

As  the  muscles  which  are  on  the  sole  of  the  foot  are  so  dif- 
ficult to  remember,  any  arrangement  which  will  facilitate  the 
recollection  of  them,  must  be  acceptable.  I  have  classed  the 
three  muscles  belonging  to  the  great  toe,  together,  viz.  the 
Abductor ',  Ftexor  Brcvis,  and  the  Adductor  Pollici* ;  then  the 
three  belonging  to  the  little  toe— the  Abductor,  Flexor  ParwiSj 
and  Adductor  Minimi  Digiti;  in  the  middle  of  the  sole  of  the 
foot  there  are  the  Flexor  Brevis  Digitorwn,  the  Flexor  Accesso- 
rius,  and  the  Lumbricafa  (as  one  muscle.)  After  these  nine 
xnusctes  are  removed,  there  are  only  the  TrcwmersaUs  and  tho 


108 

Interossei  Interni,  on  the  sole  of  the  foot ;  and   on  the  fort- 
part,  the  Extensor  Brevis  Digitorum  and  the  Interossei  Externi, 

The  following  table  of  the  origins  and  insertions  of  the 
muscles,  is  given  nearly  in  the  same  order  in  which  the 
muscles  have  been  arranged. 

GLUTEUS  MAXIMUS.  OR.  1.  The  posterior  part  of  the 
spine  of  the  os  ilium,  near  the  sacrum.  2.  From  the  con- 
vexity of  the  os  sacrum.  3.  From  the  sacro^ischiatic  liga- 
ment. 4.  From  the  os  coccygis. 

IN.  By  a  strong  broad  tendon,  under  which  is  a  largf; 
bursa,  into  the  upper  and  outer  part  of  the  linea  aspera. 

USE.  To  carry  forward  the  trunk  upon  the  thigh. 

GLUTEUS  MEDIUS.  OR.  1.  The  anterior  superior  spi- 
nous  process  of  the  os  ilium.  2.  The  edge  of  the  spine  of 
the  ilium.  3.  From  the  back  part  of  the  dorsum  of  the 
ilium. 

This  muscle  is  covered  by  a  strong  fascia,  from  which  many 
of  its  fleshy  fibres  arise. 

IN.  By  a  broad  tendon  into  the  trochanter  major. 

USE.  To  draw  the  thigh  bone  outwards,  and  a  little  bark- 
wards;  to  roll  the  thighbone  outwards,  especially  when  it  is 
bended ;  to  assist  the  former  muscle. 

GLUTEUS  MINIMUS.  OR.  A  ridge  that  is  continued  from 
the  superior  anterior  spinous  process  of  the  os  ilium,  and 
from  the  middle  of  the  dorsum  of  that  bone,  as  far  back  as  its 
great  notch. 

IN.  Into  the  fore  and  upper  part  of  the  trochanter  major. 

USE.  These  two  last  muscles  assist  the  maximus,  and,  an 
their  size  indicate,  they  are  muscles  of  the  trunk.  They 
move  the  trunk  forward  by  a  succession  of  actions. 

N.  B.  The  £SOAS  and  ILIACUS  have  been  described  at 
page  48. 

PYRIFORMIS.  OR.  From  the  2d,  3d,  and  4th  portions  of 
the  sacrum.  A  few  fleshy  fibres  from  the  OB  ilium.  It  passes 
out  of  the  pelvis  along  with  the  posterior  crural  nerve. 

IN.  By  a  round  tendon,  into  the  root  of  the  trochanter 
major. 

USE.  To  roll  the  thigh,  and  twist  the  body  forward,  on  the 
ball  of  the  great  toe. 

N.  B.  'rtie  COCCYGEUS  has  been  described  with  the  muscles 
of  tbe  perineum,  at  page  88. 

OBTURATOR  INTERNUS.  OR.  The  os  pubis  and  ischium* 
where  they  form  the  foramen  thyroideum;  and  from  the 


109  ** 

obturator  ligament,  a  flattened  tendon  passes  out  of  the  pel- 
vis, between  the  posterior  sacro-ischiatic  ligament  and  tube- 
rosity  of  the  osischium ;  it  passes  ever  thecapsular  ligament 
of  the  thigh  bone,  where  it  is  enclosed,  as  in  a  sheath,  by  the 
gemini  muscles. 

IN.  The  pit  at  the  root  of  the  trochanter  major. 

USE.  To  roll  the  thigh  bone  outwards. 

GEMINI,  OR  GEMELLUS  SUPERIOR  AND  INFERIOR.    OR.  The 

Superior,  from  the  spinous  process ;  the  Inferior,  from  the  tu- 
berosity  of  the  os  ischium ;  and  from  the  sacro-ischiatic  liga- 
ment. (They  are  united  by  a  tendinous  and  fleshy  membrane, 
over  which  the  tendon  of  the  obturator  interims  muscle 
plays.) 

IN.  The  cavity  at  the  root  of  the  trochanter  major,  on  each 
side  of  the  tendon  of  the  obturator  internus,  to  which  they 
adhere. 

USE.  The  same  as  the  last. 

QUADRATUS  FEMORIS.     OR.  The  outside  of  the  tuberosi- 
fryof  the  os  ischium,  (runs  transversely.) 
IN.  The  intertrochanteral  line  or  ridge. 
USE.  To  roll  the  thigh  outwards. 

OBTURATOR  EXTERNUS.  OR.  Fleshy,  from  the  lower  part 
of  the  os  pubis  and  ischium;  surrounds  the  foramen  thyroi- 
deum.  A  number  of  its  fibres,  arising  from  the  membrane 
which  fills  up  that  foramen,  are  collected,  like  rays,  towards 
a  centre,  and  pass  outwards  round  the  root  of  the  cervix  of 
the  os  femoris. 

IN.  By  a  strong  tendon,  into  the  cavity  at  the  root  of  the 
tvochanter  major. 

USE.  To  roll  the  thigh  bone  obliquely  outwards. 

MUSCLES  ON  THE  FORE  PART  OF  THE  THIGH. 

TENSOR  VAGINJE  FEMORIS,  OR  FASCIALIS.  OR.  The  ex- 
ternal part  of  the  anterior  superior  spinous  process  of  the  os 
ilium. 

IN.  Into  the  fascia  which  covers  the  outside  of  the  thigh. 
and  through  it  into  the  outside  of  the  knee. 

USE.  It  is  an  abductor. 

SARTORIUS.  OR.  The  anterior  superior  spinous  process 
of  the  os  ilium ;  soon  grows  fleshy,  rung  down  for  some  space 
upon  the  rectus,  and  going  obliquely  inwards,  it  passes  over 
the  vastus  internus,  and,  about  the  middle  of  the  os  femori«4 
over  part  of  the  triceps ;  it  runs  down  further  between  the 
tendon  of  the  adductor  magnus  and  that  of  the 
muscle. 

K 


110 

IN.  By  a  broad  and  thin  tendon,  into  the  inner  side  of  the 
tibia,  hear  the  inferior  part  of  its  tubercle. 

USE.  To  draw  the  leg  inward,  and  to  bend  the  knee  joint. 

GRACILIS.  OR.  By  a  thin  tendon,  from  the  os  pubis,  near 
the  symphysis  of  these  two  bones;  soon  grows  fleshy,  and, 
descending  by  the  inside  of  the  thigh,  is 

IN.  Inner  and  fore  part  of  the  tibia,  under  the  sheath  of 
the  sartorius. 

USE.  It  is  an  adductor  and  flexor. 

Under  the  name  of  the  TRICEPS  ADDUCTOR  FEMORIS,  are 
comprehended  three  distinct  muscles,  viz. 

ADDUCTOR  LONGUS  FEMORIS.  OR.  On  the  inside  of  the 
pectinalis,  from  the  upper  and  fore  part  of  the  os  pubis,  and 
ligament  of  the  symphysis. 

IN.  The  upper  third  of  the  linea  aspera. 

ADDUCTOR  BREVIS  FEMORTS.  OR.  The  os  pubis,  near  the. 
symphysis,  and  lower  than  the  last  muscle. 

IN.  The  inner  and  upper  part  of  the  linea  aspera,  from  a 
little  below  the  trochanter  minor,  to  the  beginning  of  the  in- 
sertion of  the  adductor  longus. 

ADDUCTOR  MAGNUS  FEMORIS.  OR.  1.  From  the  ramus 
of  the  os  pubis;  2.  from  the  ramus  and  the  tuberosity  of  the 
os  ischium,  as  low  down  as  the  tuberosity. 

IN.  1.  The  whole  length  of  tke  linea  aspera;  2.  into  a 
ridge  above  the  internal  condyle  of  the  os  fernoris;  3.  by -a 
long  round  tendon  (which  is  united  to  the  vastus  internus) 
into  the  upper  part  of  the  condyle. 

USE  of  these  three  muscles,  or  Triceps,  to  bring  the  thigh 
inwards  and  forwards,  as  in  clinging  to  the  saddle ;  and,  jii 
some  degree,  to  roll  the  toe  outwards.  The  pectinalis, 
which  lies  between  the  adductor  iongus  and  brevis,  may  be 
classed  with  them. 

PECTINALIS.  OR.  Broad  and  Meshy  from  the  upper  ancf 
anterior  part  of  the  OB  pubis,  immediately  above  the  fbramew 
thyroideum. 

IN.  Into  the  anterior  and  upper  part  of  the  linea  aspera  of 
the  os  femoris,  a  little  below  the  trochanter  minor,  by  a  flat 
and  short  tendon. 

USE.  To  bring  the  thigh  upwards  and  inwards. 

QUADRICEPS  EXTENSOR  CRURIS,  is  composed  of  the  fen* 
following  muscles  .* — 

RECTUS.  OR.  1.  The  lower  and  anterior  spinou*  j»roeesg 
of  the  os  ilium;  2.  tendinous  from  the  dersum  of  the  ilium,  a 
little  above  the  aeetabuhim. 


IN.  The  upper  part  of  the  patella,  and  through  the  medium 
of  the  patella,  and  its  ligament,  into  the  anterior  tubercle  of 
the  tibia. 

USE.  To  extend  the  leg,  or  raise  the  body. 

VASTUS  EXTERNUS.  OR.  1.  The  root  of  the  trochanter 
major;  2.  the  whole  length  of  the  linea  aspera,  by  fleshy  fi- 
bres which  run  obliquely  forwards  to  a  middle  tendon,  where 
they  terminate. 

IN.  The  patella ;  part  of  the  muscle  ends  in  an  aponeuro- 
sis,  which  is  continued  down  on  the  leg,  and  is  firmly  fixed 
to  the  head  of  the  tibia. 

USE.  To  extend  the  leg,  or  raise  the  body  from  the  seat. 

VASTUS  INTERNUS.  OR.  1.  The  fore  part  of  the  os  femo- 
ris;  2.  root  of  the  trochanter  minor;  3.  almost  all  the  inside 
of  the  linea  aspera;  the  fibres  run  obliquely  forwards  and 
downwards,  and  it  is  fleshy  considerably  lower  than  the  last. 

IN.  The  patella ;  part  of  this  also  ends  in  an  aponeurosis, 
which  is  continued  down  the  leg. 

USE.  To  extend  the  leg,  or  raise  the  body. 

CRURJEUS.  OR.  1.  From  between  the  two  trochanters  of 
the  os  femoris ;  2.  it  adheres  firmly  to  all  the  fore  part  of  the 
os  femoris,  and  joins  the  vasti  muscles. 

IN.  The  patella,  (behind  the  reef  as.) 

USE.  To  assist  the  three  last  muscles. 

MUSCLES  LYING  ON  THE  BACK  OF  THE  THIGH. 

FLEXORS  OF  THE  LEG. 

SEMTTENDINOSUS.  OR.  The  posterior  part  of  the  tubero- 
sity of  the  os  ischium,  in  common  with  the  long  head  of  the 
biceps,  to  which  it  is  connected  by  fleshy  fibres  to  the  extent 
of  two  or  three  inches.  . 

l.\.  The  ridge,  and  inside  of  the  tibia,  a  little  below  its 
tubercle. 

USE.  To  bend  the  leg. 

SBMIME,MBJIANOSUS.     OR,  B^  a  strong  tencon,  from  the 
upper  and  backmost  part  of  the  tuberosity  of  the  os  ischium. 
IN.  The  inner  and  back  part  of  the  head  of  the  tibia. 
USE.  To  bend  the  leg. 
N,  B.  The  two  last  form  the  inner  ham-string. 

BICEPS  FLEXOR  CRURIS.  OR.  (Two  distinct  heads,)  the 
first,  longus,  in  common  with  the  semitendinosus,  from  the 
back  and  outer  part  of  the  tuberosity  of  the  ischium ;  the  se- 
cond, breyis,  trom  the  linea  aspera, — beginning  a  little  below 


112 

the  insertion  of  the  gluteus  maximus,  it  continues  to  take  its- 
attachment,  till  within  a  hand's  breadth  of  the  condyle. 

IN.  Head  of  the  fibula  and  ligaments. 

USE.  To  bend  the  leg. 

POPLITEUS.  OR.  The  lower  and  back  part  of  the  external 
condyle  of  the  os  femoris,  on  the  back  of  the  joint. 

IN.  The  ridge  on  the  inside  of  the  tibia,  a  little  below  its 
head. 

USE.  To  assist  in  bending  the  leg. 

MUSCLES  LYING  ON  THE  BACK  OF  THE  LEG. 

GASTROCNEMIUS  EXTERNUS,  OR  GEMELLUS.  OR.  1.  The 
upper  and  back  part  of  the  internal  condyle  of  the  fernur,  and 
from  that  bone,  a  little  above  its  condyle;  2.  the  second  head 
arises.tendinous  from  the  upper  and  back  part  of  the  external 
condyle  of  the  femur.  After  forming  two  beautiful  bellies, 
which  are  united  by  a  middle  tendon,  the  muscle  terminates 
in  the  tendo  Achillis. 

SOLE  us,  OR  GASTROCNEMIUS  INTERNUS.  OR.  (Two  ori- 
gins.) 1.  The  upper  and  back  part  of  the  head  of  the  fibula, 
continuing  to  receive  many  of  its  fleshy  fibres  from  the  pos- 
terior part  of  that  bone,  for  some  space  below  its  head. 
2.  From  the  back  part  of  the  tibia,  lower  down  than  the  in- 
sertion of  the  popliteus.  The  flesh  of  this  muscle,  covered 
by  the  tendon  of  the  gemellus,  runs  down,  nearly  to  the  lower 
end  of  the  tibia — by  the  tendo  Achillis. 

IN.  Into  the  backmost  part  of  the  os  calcis,  by  the  projec- 
tion of  which  these  muscles  gain  a  considerable  leve*r  power. 

USE.  To  extend  the  foot. 

PLANTARIS.  OR.  The  upper  and  back  part  of  the  exter- 
nal condyle  of  the  femur;  it  adheres  to  the  ligament  of  the 
joint.  It  passes  under  the  gastrocnemius,  and  forming  a 
long  slender  tendon,  then  runs  down  by  the  inside  of  the  ten- 
do  Achillis. 

IN.  The  inside  of  the  os  calcis. 

USE.  From  its  delicacy,  and  insufficiency  to  assist  the  last 
muscles,  it  is  supposed  to  have  a  use  in  pulling  the  capsular 
ligament  of  the  knee  from  between  the  bones. 

THE  THREE  DEEP  MUSCLES,  ARE  THE 

TIBIALIS  POSTICUS.  OR.  1.  The  fore  and  upper  part  ot 
the  tibia,  just  under  the  process  which  joins  it  to  the  fibula. 
2.  Then  passing  through  a  perforation  in  the  upper  part  of 
the  interosseous  ligament,  it  continues  its  origin  from  the 
back  part  of  the  fibula  next  the  tibia.  3.  From  near  one  hall' 


113 

te  upper  and  back  part  of  the  tibia.  4.  From  theinteros- 
.seous  ligament, — the  tendon  passes  behind  the  malleolus 
interims. 

IN.  Spreads  wide  in  the  bottom  of  the  foot,  and  is  inserted 
into  the  os  cuneiforme  internum  and  medium ;  and  also  to 
the  os  calcis,  os  cuboirles,  and  to  the  root  of  the  metatarsal 
bone  that  sustains  the  middle  toe. 

USE.  To  extend  the  foot,  and  to  turn  the  toes  inwards. 

FLEXOR  LONGUS  DTGITORUM  PEDTS  PERFORANS.  OR.  The 
back  part  of  the  tibia,  some  way  below  its  head,  and  near  the 
entry  of  the  medullary  artery;  from  this,  it  is  continued 
down  the  inner  edge  of  the  bone ;  also,  by  tendinous  and 
fleshy  fibres,  from  the  outer  edge  of  the  tibia  ;  between  thi* 
double  order  of  fibres  the  tibialis  posticus  muscle  lies  en- 
closed. Having  passed  under  two  annular  ligaments,  it  then 
passes  through  a  sinuosity  at  the  inside  of  the  os  calcis,  and, 
about  the  middle  of  the  sole  of  the  foot,  divides  into  four  ten- 
dons, which  pass  through  the  slits  in  the  perforatus.  Just 
before  its  division,  it  receives  a  considerable  tendon  from  that 
of  the  flexor  pollicis  longus. 

IN.  Into  the  extremity  of  the  last  joint  of  the  four  lesser 
toes. 

USE.  To  bend  the  last  joint  of  the  toes. 

This  muscle  is  assisted  by  the  accessorius.  See  dissection 
of  the  sole  of  the  foot. 

FLEXOR  LONGUS  POLLICIS  PEDIS.  OR.  By  an  acute,  ten- 
dinous, and  fleshy  beginning  from  the  posterior  part  of  the 
fibula,  some  way  below  its  head,  being  continued  down  the 
same  bone,  almost  to  its  inferior  extremity,  by  a  double  order 
of  oblique  fleshy  fibres  ;  its  tendon  passes  under  an  annular 
ligament  at  the  inner  ankle. 

IN.  Into  the  last  joint  of  the  great  toe.  It  generally  sends 
a  small  tendon  to  the  os  calcis. 

USE.  To  bend  the  last  joint  of  this  toe. 

MUSCLES  ON  THE  FORE  PART  OF  THE  LEG. 

PERONEUS  LONGUS.  OR.  From  the  head,  and  whole 
length  of  the  fibula,  as  far  down  as  to  within  a  hand's  breadth 
of  the  ankle.  The  tendon  passes  through  a  channel  at  the 
outer  ankle,  at  the  back  of  the  lower  head  of  the  fibula  ;  it 
then  runs  along  a  groove  in  the  os  cuboides,  across  the  sole 
«f  the  foot. 

IN.  The  root  of  the  metatarsal  bone  that  sustains  the  great 
foe,  and  the  os  cuneiforme  internum. 

USE.  To  move  the  foot  outwards,  and  t*  press  dawn  the 
5a!l  of  the  great  toe. 


114 

PERONEUS  BREVIS.  OR.  From  the  middle  and  lower  par* 
of  the  fibula;  from  the  fibula,  above  the  middle;  from  the 
outer  side  of  the  anterior  spine  of  this  bone ;  and  also  from 
its  round  edge  externally,  the  fibres  running  obliquely  out- 
wards, towards  a  tendon  on  its  external  side.  It  sends  off  a 
round  tendon,  which  passes  through  the  groove  at  the  outer 
ankle,  being  there  included  under  the  same  ligament  with 
that  of  the  preceding  muscle ;  and  a  little  farther,  it  runs 
through  an  appropriate  sheath. 

IN.  The  root  and  external  part  of  the  metatarsal  bone  that; 
sustains  the  little  toe. 

USE.  To  direct  the  foot  outwards,  and  by  pressing  the  ball 
of  the  great  toe  to  the  ground,  to  assist  in  carrying  forwards 
the  whole  body. 

PERONEUS  TERTIUS.  OR.  The  middle  of  the  fibula,  down 
to  near  its  inferior  extremixity ;  the  tendon  passes  under  the 
annular  ligament. 

IN.  The  root  of  the  metatarsal  bone  that  sustains  the  little 
toe. 

USE.  To  assist  the  other  peronei  muscles. 

N.  B.  The  belly  of  this  muscle  is  united  to  the  extensor 
digitorum. 

TIBIALIS  ANTICUS.  OR.  1.  The  process  of  the  tibia  to 
which  the  fibula  is  connected  above.  2.  The  outside  of  the 
tibia.  3.  The  upper  part  of  the  interosseous  ligament. 

IN.  The  inside  of  the  os  cuneiforme  internum,  and  nearer 
extremity  of  the  metatarsal  bone  that  sustains  the  great  toe. 

USE.  To  bring  the  foot  to  right  angles  with  the  leg. 

EXTENSOR  LONGUS  DIGITORUM  PEDIS.  OR.  1.  The  ouU 
.side  of  the  head  of  the  tibia.  2.  The  head  of  the  fibula, 
where  it  joins  with  the  tibia,  and  spine  of  the  fibula.  3. 
From  the  interosseous  ligament.  4.  From  the  tendinous 
fascia  which  covers  the  outside  of  the  leg. 

IN.  The  root  of  the  first  bone  of  each  of  the  four  small 
toes,  and  is  expanded  over  the  upper  side  of  the  toes,  as  far 
as  the  root  of  the  last  bone. 

USE.  To  extend  the  four  lesser  toes. 

•  EXTENSOR  PROPRIUS  POLLICIS  PEDIS.  OR.  Beginning- 
some  way  below  the  head  and  anterior  part  of  the  fibula „ 
along  which  it  runs  to  near  its  lower  extremity,  connected 
to  it  by  a  number  of  fleshy  fibres,  which  descend  obliquely 
towards  a  tendon. 

IN.  The  first  and  last  joint  of  the  great  toe. 

USE.  To  extend  the  great  toe. 


115 

MUSCLES  OF  THE  SOLE  OF  THE  FOOT,  AFTER; 
DISSECTING  THE  PLANTAR  APONEUROSIS, 

SHORT  MUSCLES  OF  THE  GREAT  TOE, 

ABDUCTOR  POLLICIS  PEDIS.  OR.  The  inside  of  the  pro- 
tuberance of  the  os  calcis,  where  it  forms  the  heel:  and  from 
the  same  bone,  where  it  joins  wtth  the  os  naviculare. 

IN.  The  internal  os  sesamoideum,  and  root  of  the  first  joint 
of  the  great  toe. 

USE.  To  pull  the  great  toe  from  the  rest ;  but  its  power  is 
lost  by  the  use  of  shoes. 

FLEXOR  BREVIS  POLLICIS  PEDIS.  OR.  1.  The  under  and 
fore  part  of  the  os  calcis,  where  it  joins  with  theos  cuboides, 
2.  From  the  os  cuneiforme  externum ;  it  is  inseparably  uni- 
ted with  the  abductor  and  adductor  pollicis. 

IN.  The  external  sesamoid  bone,  and  root  of  the  first  bone 
of  the  great  toe. 

ADDUCTOR  POLLICIS  PEDIS.  OR.  1.  The  os  calcis.  2. 
The  os  cuboides.  3.  The  os  cuneiforme  externum,  from  the 
root  of  t-he  metatarsal  bone  of  the  great  toe. 

USE.  To  bring  this  toe  nearer  the  rest ;  but  by  the  pres- 
vstire  of  the  shoe,  its  power  is  much  reduced. 

MUSCLES  OF  THE  LITTLE    TOE. 

ABDUCTOR  MINIMI  DIGITI  PEDIS.  OR.  Side  of  the  pro- 
tuberance of  the  os  calcis,  and  from  the  root  of  the  metatar- 
sal  bone  of  the  little  toe. 

IN.  The  root  of  the  first  bone  of  the  little  toe. 

USE.  To  draw  the  little  toe  outwards  from  the  rest ;  and 
also  to  bend  the  toe. 

FLEXOR  BREVIS  MINIMI  DIGITI  PEDIS.  OR.  1.  The  os 
cuboides,  near  the  furrow  for  the  tendoji  of  the  peroneus  Ion 
gus.  2.  The  outside  of  the  metatarsal  bone  that  sustains 
this  toe. 

IN.  The  first  bone  of  this  toe. 

USE.  To  bend  the  toe. 

N.  B.  There  is  no  proper  ADDUCTOR  MINIMI  DIGITS  but 
we  may  class  one  of  the  Internal  Interossei  as  an  Adductor. 

FLEXOR  BREVIS  DIGITORUM  PEDIS,  PERFORAUS.  OR.  The 
inferior  and  back  part  of  a  protuberance  of  the  os  calcis  (be 
tween  the  abductor  of  the  great  and  little  toes.)    It  sends 
off  four  tendons,  which  split,  for  the  transmission  of  the  ten- 
dons of  the  flexor  longus, 


116 

I.N.  The  second  phalanx  of  the  four  lesser  toes.     (Tik- 
tendon  of  the  little  toe  is  often  wanting.) 
USE.  To  bend  the  second  joint  of  the  toes. 

PLEXOR  DIGITORUM  ACCESSORIUS,  OR  MASSA  CARNEA. 
.1  ACOBI  SYLVII.  OR.  The  sinuosity  at  the  inside  of  the  os 
calcis,  the  fore  part  of  the  bone. 

IN.  The  tendon  of  the  flexor  longus,  just  at  its  division 
into  four  tendons. 

USE.  To  assist  the  flexor  longus,  and  to  change  the  direc- 
tion of  its  operation. 

LUMBRICALES  PEDIS.  Are  four  in  number.  Each  has  ite 
origin  thus  :  OR.  The  tendon  of  the  flexor  profundus,  just 
before  its  division,  and  near  the  insertion  of  the  massa  car- 
nea. 

IN.  The  inside  of  the  first  joint  of  the  toe.  It  is  lost  in 
the  tendinous  expansion  that  is  sent  from  the  extensor  tendon 
to  cover  the  upper  part  of  the  toe. 

USE.  Flexors. 

TRANSVERSALIS  PEDIS.  OR.  The  extremity  of  the  meta- 
tarsal  bone  of  the  great  toe ;  the  internal  os  sesamoideum  of 
the  first  joint  (adheres  to  the  adductor  pollicis.) 

IN.  The  anterior  extremity  of  the  nietatarsal  bone  of  the 
little  toe,  and  ligament  of  the  next  toe. 

USE.  To  contract  the  foot,  by  bringing  the  great  toe  and 
the  two  outermost  toes  nearer  each  other,  and  to  support  the 
lateral  arch  of  of  the  foot. 

INTEROSSEI  PEDIS  LNTERNI.  The  first,  which  is  called 
Adductor  JVfedii  DigUi  Pedis,  arises  from  the  inside  of  the 
root  of  the  metatarsal  bone  of  the  middle  toe*  and  is  inserted 
into  the  inside  of  the  root  of  the  first  joint  of  the  middle  toe  : 
f  he  two  others,  which  are  called  Adductor  Tertii  Digiti  Pedis 
MTU!  Adductor  Minimi  Digiti,  rise  in  the  same  manner. 

MUSCLES  SITUATED  ON  THE  FOSIE  PART 
OF  THE  FOOT. 

EXTENSOR  BREVIS  DIGITORUM  PEDIS.  OR.  The  fore  and 
upper  part  of  the  os  calcis ;  it  divides  into  four  portions,  which 
send  tendons  that  pass  over  the  upper  part  of  the  foot,  under 
the  tendons  of  the  former. 

IN.  The  tendinous  expansion  which  covers  the  toes  ex- 
cept the  little  one. 

USE.  To  assist  in  extending  the  toes,  and  somewhat 
••hange  the  direction  of  the  force  of  the  long  extensor- 


117 

INTEROSSEI  PEDIS  EXTERNI  BICIPIT*:S.  There  are  four  of 
ihese  muscles,  each  of  which  arises,  1>y  two  origins,  from 
the  metatarsal  bones,  between  which  they  lie.  The  following 
names  have  been  given  to  them  : — Abductor  Indicis  Pedis  ;-- 
Adductor  Indicis  Pedis ; — Abductor  Medii  Dig-it i  Pedis  ;— 
Abductor  Tertii  Digiti  Pedis. 


DISSECTION 

OP  THE 

LIGAMENTS  OF  THE  PELVIS, 

AND  OF 

THE   JOINTS  OF    THE  LOWER  EXTREMITIES. 


THE  dissection  of  the  ligaments  of  the  upper  part  of  the 
pelvis  is  generally  a  very  unpleasant  task  for  the  young  stu- 
dent, because  it  is  seldom  made  until  the  parts  are  almost 
putrid. 

If  the  muscles  are  much  decayed,  they  should  be  remov- 
ed, and  the  pelvis  put  into  water  for  a  day  or  two.  But  the 
best  method  of  proceeding  is,  either  to  remove  the  muscles 
while  they  are  fresh,  and  to  dissect  the  ligaments  of  the  pel- 
vis before  the  muscles  below  the  knee  are  examined,  or  to 
allow  the  parts  to  lie  in  water  until  the  muscles  become  so 
soft  that  they  can  be  easily  separated  from  the  ligaments. 

The  ligaments  of  the  pelvis  may  be  divided  into  several 
distinct  sets  : — 1st.  those  which  unite  the  vertebrae  and  the 
sacrum ;  2d.  the  ligaments  which  run  from  the  ilium  to  the 
vertebrae :  3d.  those  which  are  between  the  ilium  and  the 
sacrum  ;  but  all  these  are  of  very  trifling  importance,  com- 
pared to  those  which  are  between  the  bones  at  the  outlet  of 
the  pelvis. 

The  ligaments  which  are  between  the  lumbar  vertebrae 
and  the  sacrum,  are  so  similar  to  those  of  the  spine,  that  I 
shall  omit  the  description  of  them  here.  But  if  we  pull  the 
spine  from  the  ilium,  before  we  remove  the  muscles  which 
lie  between  the  ilium  and  the  last  vertebr®,  we  shall  liiid 


118 

thai  the  bones  are  held  together  by  two  ligaments, — one 
of  which  passes  from  the  crest  of  the  ilium  to  the  trans- 
verse process  and  body  of  the  last  lumbar  vertebra,  and  is 
called  Ligamentum  Anticum  Superius.  This  ligament  is 
often  of  a  triangular  form>  in  consequence  of  a  small  portion 
of  it  passing  also  to  the  fourth  vertebra.  The  Ligamentum 
Anticum  Inferius  runs  from  the  same  point  as  the  other,  to- 
wards the  union  of  the  last  vertebra  with  the  sacrum. 

The  principal  connection  between  the  sacrum  and  ilium, 
is  at  the  sacro  iliac  symphysis,  through  the  medium  of  a  fibro 
cartilaginous  structure,  which  is  sometimes  called  the  Sacro 
Iliac  Ligament ;  but  this  cannot  be  seen  until  all  the  ligaments 
are  cut  through,  and  the  bones  torn  asunder.  Some  small 
ligaments  will  be  seen,  after  the  muscles  which  lie  between 
the  sacrum  and  ilium  are  removed.  These  ligaments  have 
been  commonly  called  L-igamenta  Dorsalia  raga  ;  but  by 
Weiibrecht)  that  indefatigable  dissector  of  ligaments,  they 
have  been  divided  into  three  distinct  portions, — and  if  we 
have  patience,  enough  we  may  do  the  same.  We  shall  find 
one  portion  passing  from  the  superior  posterior  spinous  pro- 
cess of  the  ilium,  to  the  transverse  process  of  the  fourth 
bone  of  the  sacrum  ;  this,  Weitbrecht  has  called  the  Liga- 
mentum Posticum  Longum  Ossis  I  Hi.  By  raising  this  liga- 
ment, the  Ligamentum  Posticum  Breve  Ossis  Ilii  will  be  found 
running  from  the  same  point  to  the  third  bone :  and  from  the 
internal  part  of  the  same  spine,  the  Ligamentum  Laterale 
parses  to  the  inferior  margin  of  the  first  bone  of  the  sacrum. 

The  most  important  ligaments  are  those  situated  at  the 
outlet  of  the  pelvis :  to  dissect  these,  it  is  only  necessary  to 
remove  the  muscles.  We  shall  first  expose  the  Sacro  Ischia- 
tic-urn  Majiis,  or  Posterius,  which  arises  from  the  posterior 
part  of  the  crest  of  the  ilium,  and  from  the  sides  and  poste- 
rior part  of  the  sacrum  and  os  coccygis,  and  is  attached  to 
the  tuberosity  of  the  ischium.  The  portion  of  this  ligament 
which  runs  up  towards  the  superior  posterior  spinous  process 
of  the  ilium,  is  called  the  Superior  Appendix;  but  a  more 
important  portion,  is  that  which  may  be  traced  from  the  tu- 
berosity of  the  ischiurn,  towards  the  ramus  of  the  pubes.  It 
is  called  the  Productio  Falciformis  of  Winslow.  (a) 

(a)  Since  no  particular  description  of  the  Triangular  Liga- 
ment of  the  Urethra  has  been  given : — from  its  connexion 
with  what  is  called  the  productio  falciformis  of  Winslow  and 
from  being  really  a  ligament  of  the  pelvis  I  shall  introduce  it 
in  this  place.  This  ligament  then  is  situated  across  the  arch 
and  between  the  rarni  of  the  pubes;  is  connected  above 
to  the  under  part  of  the  annular  or  capsular  of  the  symphy 


119 

The  Lig  amentum  Sacro  IscHaMcwn  M'ntis,  or 
will  be  seen  above  the  last,  rising  from  the  sides  of  the  sa- 
crum and  os  coccygis,  and  attached  to  the  spine  of  the 
ischium. 

The  [os  coecygis  is  united,  in  early  life,  to  the  sacrum,  bv 
ligaments  analogous  to  those  of  the  bodies  of  the  vertebrae ; 
but  no  distinct  ligaments  can  now  be  shown,  for  the  bands 
covering  the  anterior  and  posterior  parts  of  the  bone,  are 
merely  continuations  from  the  Ligamenta  Vaga^  which  con- 
nect the  bones  of  the  sacrum. 

The  ossa  pubis  are  united  together  by  an  intermediate  car-= 
tilage,  which  has  a  considerable  similarity  to  the  interverte- 
bral  substance.  It  has  been  called  the  Commissvra  O^ium 
Pubit,  and  is  strengthened  by  a  ligament,  to  which  the  name 
ofAnnulus  Ligamento&us  has  been  given. 

The  obturator  foramen  is  all  closed  by  the  JWe-mbrana  Ob- 
iurans,  except  a  small  portion  at  the  upper  part,  which  is  for 
the  transmission  of  the  obturator  artery  and  nerve. 

The  Pouparfs  Ligament  is  sometimes  described  as  one 
holding  the  bones  of  the  pelvis  together.  It  is  curious  that 
Weitbrecht  calls  this  the  <(  f^exatusimum  Ligamentum."  It 
may  be  truly  so  called  still.  Poupart  first  described  it,  from 
the  dissection  of  a  goat;  and  since  his  time,  up  to  this  day, 
there  has  always  been  a  dispute,  whether  it  is  a  distinct  liga- 
ment, or  only  part  of  the  tendon  of  the  external  oblique  muscle. 
Weitbrecht  considers  it  as  a  separate  ligament ;  and  this  is 
probably  the  most  correct  view.  But  we"  shall  not  say  morf 
upon  it,  as  it  has  been  already  sufficiently  dwelt  upon  in  the 
description  of  the  abdominal  muscles. (a) 

feis  ;  and  is  about  an  inch  and  an  half  in  depth.  It  is  about 
half  an  inch  thick ;  but,  gradually  lessening,  its  lower  edge 
is  thin.  At  this  part  near  the  bone  on  each  side  the  produc- 
tio  falciformis  is  continuous  with  the  ligament,  by  which  it 
appears  to  be  drawn  down  towards  the  tuberosities  of  the 
ischia ;  and  from  the  attachment  of  the  sphincter  ani,  with 
the  muscles  of  the  perineum,  into  a  middle  point  at  the  un- 
der edge  of  this  ligament  the  appearance  of  a  double  arch  is 
exhibited.  By  this  connection  the  triangular  ligament  serves 
"to  support  the  viscera  of  the  pelvis,  and  assist  in  the  joining* 
at  the  synisjphysis  pubis.  At  about  the  centre  of  the  ligament 
is  a  hole  fdr  the  passage  of  the  urethra  from  the  bulb,  and 
Cowper's  glands  are  to  be  found  in  the  substance  of  the  liga- 
ment on  each  side  this  opening,  which  accounts  for  its  greater 
thickness  at  it3  upper  part. 

(a)  I  think  it  right  to  introduce  here  a  description  of  the 
Arch,   fo?  from  its  structure  stncl  connexions ;  i( 


120 

TABLE  OF  THE  LIGAMENTS  OF  THE  PELVI& 

(ON  THE  UPPER  PART.) 

1 .  Ligamentum  Anticum  Superins. 

2.  ' Inferius. 

3.  _* Sacfo  Iliacum. 

4.  Ligamenta  Dorsalia  Vaga?—  divided  info-*- 

a.  Ligamentum  Longum  Ossis  Ilii. 

b.  = Breve. 

c.  Laterale. 

may  be  enumerated  with  the  ligaments  of  the  pelvis,  with 
equal  propriety  as  Poupart's  ligament.  For  this  purpose, 
I  shall  transcribe  from  my  Surgical  Anatomy,  published 
New- York,  1822. 

k'  I  am  perfectly  aware,  that  in  the  majority  of  instances, 
what  I  am  about  now  to  delineate,  has  the  appearance  of 
unity  with  Poupart's  ligament:  but  from  having  so  often  seen 
them  separate,  I  have  ventured  at  a  method  of  description, 
which  is  a  little  out  of  the  common  order  pursued  by  anato- 
mists. I  am  not,  however,  altogether  without  precedent  for 
this  plan,  since  Mr.  Hey,  in  the  iirst  edition  of  his  Practical 
Observations  on  Surgery,  had  adopted  it ;  and  moreover,  as 
Mr.  Robert  Liston,  of  Edinburgh,  has  written  a  book  solely 
upon  the  subject  of  the  crural  arch. 

In  the  course  of  my  late  dissections,  I  have  frequently 
been  led  to  a  very  careful  examination  into  the  ligamentous 
structure  at  the  groin ;  in  order  that  I  might  satisfy  myself 
of  the  particular  disposition  of  those  tendinous  fibres,  whicli 
form  the  ultimate  seat  of  stricture  in  femoral  hernia. 

As  was  to  be  expected,  I  found  the  ligament,  of  Poupart, 
running  in  a  straight  direction,  after  the  parts  connected 
with  it  were  in  a  relaxed  state ;  but  I  also  observed,  what 
has  been  described  as  the  third  insertion  of  the  external 
oblique  muscle,  to  be  a  considerable  ligamentous  band,  run- 
ning in  an  arched  course,  in  the  direction  of  the  anterior  part 
of  the  crural  sheath  ;  having  its  inner  attachment  from  the 
ligament  covering  the  spinous  ridge  of  the  pubis,  about  an 
inch  from  the  tuberosity ;  and  outwardly,  its  fibres  seemed  to 
seek  connexion  with  the  inferior  anterior  epinous  process  of 
the  ilium  ;  by  going  between  the  psoas  and  iliacus  muscles* 
as  they  come  out  of  the  pelvis. 

This  crural  arch  at  its  inner  and  upper  part,  I  have  seen 
in  many  instances,  quite  distinct  from  Poupart's  ligament, 
having  only  a  membraneous  joining  with  it,  similar  to  that 
uniting  the  two  columns  of  the  tendon,  of  the  external  oblique, 
as  they  go  to  form  the  external  ring.  At  about  the  centre  of 


121 

* 
(6N  THE  LOWER  PART.) 

t.  Ligametituni  Sacro  Ischiaticum  J^Iajus^ — with  its  two 

appendages, — 

Appendix  ^Superior,    and    Productio   Falciformis  of 
Winslow. 

2.  Ligamentum  Sacro  Ischiaticwn  JNiinus* 

3.  Ligamenta  Vaga. 

(On  the  inside  of  the  sacrum.) 

4.  Ccnnmissura  Ossium  P-ubis. 

5.  Annulus  Ligamentosus. 

6.  Memhrana  Obturans. 

7.  Liganientum  PoupartiL 

this  arch,  however,  the  fibres  become  in  close  contact  with 
Poupart's  ligament,  and  firmly  adhere  to  it,  by  which  their 
arched  course  is  sustained;  yet  the  fibres  are  not  incorpora- 
ted here  with  those  of  Poupart's  ligament,  as  can  be  de- 
termined by  maceration.  After  passing  this  centre,  th" 
fibres  of  the  crural  arch  again  separate  from  those  of  Pou- 
part's ligament,  and  disappear  between  the  psoas  and 
iliacus  interims  muscles.  Thus  we  have  a  ligamentous 
structure  distinct  from  Poupart's  ligament,  distant  from  the 
tendon  of  the  external  oblique  ;  having  attached  to  it  in  close 
union  the  process  of  fascia  transversalis  that  descends  into 
the  thigh;  and  prescribing  limits  to  the  mouth  of  the  cru- 
ral sheath.  It  is  this  which  Gimbernat  found  only  necessary 
to  divide,  to  relieve  the  stricture  in  femoral  hernia ;  and  it  is 
this  also,  to  which  Mr.  Hey,  in  the  first  edition  of  his  Surgi- 
cal Observations,  has  given  the  name  of  femoral  liga- 
ment. 

Now,  although  the  separation  between  the  fibres,  of 
what  I  have  here  called  exclusively,  the  crural  arch  ;  and 
Poupart's  ligament,  is  not  always  to  be  found  equally  dis- 
tinct ;  yet  the  arched  course  of  the  one  set,  I  believe  to  bt> 
always  present,  in  opposition  to  that  of  the  other,  which 
from  their  nature  of  attachment,  must  run  in  a  direct 
line.  That  the  crural  arch  is  always  to  be  found,  is  proved 
by  the  acknowledged  invariable  oval  shape  of  the  mouth  of 
the  crural  sheath,  when  beheld  from  the  abdominal  aspect. 

To  the  fact  then :  that,  immediately  in  contact  with  and 
ever  the  anterior  part  of  the  mouth  of  the  crural  sheath, 
binding  it  down  from  the  linea-ileo-pectinea,  at  about  an 
inch  from  the  tuberosity  of  the  pubis,  to  the  os  ilium  below 
the  superior  spinous  process ;  are  tendinous  fibres  running  in 
as  arched  direction,  and  placed,  throughout  their  course, 
from  being  in  contact  with,  to  within  the  distance  of 

L 


122 

There  is  very  little  dissection  necessary,  to  show  the  liga- 
ments of  the  hip  joint,  for  if  all  the  muscles*  are  raised,  the 
only  ligament  which  surrounds  the  joint  will  be  seen.  This 
is  a  very  strong  ligament,  arid  is  called  the  Ligctmentum  Cap- 
mlare.  It  takes  an  attachment  round  the  acetabulum,  and 
descends  to  the  line  between  the  trochanters,  in  front,  and  to 
the  same  extent  on  the  back  part,  so  as  to  embrace  the  whole 
of  the  head  and  neck  of  the  bone.  The  ligament  is  strength- 
ened, on  the  anterior  part,  by  a  band  of  fibres  which  run 
from  the  anterior  spinous  process  of  the  ilium,  form  iheLiga- 
mcntum  Accessorium  Anticum.  A  similar  band  may  be  seen 
on  the  posterior  part,  and  which  forms  the  Ligamentvm  Ac- 
ccssorium  Posticum.  By  cutting  through  the  capsular  liga- 
ment, which  is  in  some  parts  very  strong,  we  shall  expose 

below  Poupart's  ligament ;  also  ,that  it  is  the  sharp  and  inner 
edge  of  this,  "which  becomes  the  principal  and  ultimate  seat 
of  stricture  in  femoral  hernia  ; — does  this  practical  inference 
follow — that  we  are  not  to  expect  much  relief  to  the  stran- 
gulated intestine,  in  femoral  hernia,  by  elevating  the  thigh 
and  relaxing  the  muscles  and  fasciae,  connected  with  Pou- 
part's ligament.  Hence,  we  are  not  to  hold  in  high  expec- 
tancy, the  reduction  a  femoral  hernia,  by  the  taxis ;  for  we 
are  told  by  Sir  Astley  Cooper,  that,  uin  the  inguinal  hernia. 
the  parts  are  so  connected  with  muscles,  that  any  relaxation 
brought  upon  these,  affects  the  aperture  through  which  the 
hernia  descends:  but  in  the  crural  hernia,  the  seat  of  the 
stricture  is  in  parts  less  connected  with  the  action  of  mus- 
cles, and  general  relaxation  has  but  little  ei  ect  upon  them" 
and  "  the  delay  of  the  operation,  which  I  lamented  and  con- 
demned, when  speaking  of  inguinal  hernia,  is  to  be  still  more 
deprecated  in  the  crural ;  for  death  very  generally  happens- 
earlier  in  the  latter  disease  than  in  the  former."  And  Mr. 
Lawrence  also,  notwithstanding  he  has  disagreed  with  Mr. 
Hey's  notions,  of  a  femoral  ligament  or  crural  arch,  distinct 
from  the  ligament  of  Poupart,  speaks  with  some  emphasis, 
in  reference  to  the  hope,  that  is  to  be  entertained,  for  the  re- 
duction of  a  femoral  hernia  by  the  taxis.  "  Let  the  practi- 
tioner remember,  that  the  smallness  of  the  mouth  of  the  sac, 
and  the  consequent  tightness  of  the  stricture,  diminish  the 
chance  of  effecting  a  replacement  of  the  rupture,  by  means  of 
the  taxis;  and  consequently,  that  when  the  incarceration  is 
completely  formed,  he  should  not  waste  much  time  in  at* 
tempts  of  this  description.'  " 

*  A  large  bursa  will  be  seen,  in  cutting  away  the  tendon  of 
the  gluteus  maximus ;  and  generally  another,  under  the  ten- 
dons of  the  iliaeus  ihternus,  and  psoas  magnus. 


123 

the  edge  of  the  acetabulum  ;  but  the  bones  will  not  yet  fall 
separate,  because  the  form  of  the  acetabulum  is  such,  that 
it  surrounds  part  of  the  head,  so  as  to  hold  it  in  its  place,  in- 
dependent of  the  ligaments  ;  but  by  pulling  a  little,  the  femur 
will  be  easily  displaced  :  and  now  the  ligament,  which  is 
•called  by  some  Ligamentum  Teres,  by  others,  Ligamentiwi 
Truwscuhire,  will  be  seen  rising-  from  the  bottom  of  the  ace- 
tabulum, and  passing  to  the  head  of  the  femur.  With  a  very 
slight  jerk,  this  ligament  may  be  torn  ;  and  then  we  shall  see 
a  fatty  substance  at  the  bottom  of  the  acetabulum,  which 
has  been  called  the  Apparatus  Mucosm,  There  are  some 
little  bands  connecte  1  with  it,  which  are  called  Ligamentulce 
Adiposce. 

The  femur  being  removed,  we  should  now  compare  the 
size  of  the  acetabulum,  with  that  in  the  skeleton.  We  shall 
see  that  it  is  much  deepened  by  the  addition  of  a  ring  of  lig- 
amentous  cartilage,  which  surrounds  its  edge.  "  On  the  inner 
part,  where  the  bone  is  deficient,  a  distinct  portion  of  liga- 
ment will  be  seen,  running  across  the  lower  part  of  the  ace- 
tabulum ;  this  has  been  called  the  Ligimentnm  Transversals^ 
while  the  portion  which  encircles  the  edge  of  the  acetabu- 
luin,  is  called  the  .Ligament  'im  L'thri  Cartll  t^'inemn.  When 
we  examine  the  neck  of  the  femur,  we  may  see  some  small 
slips  of  ligament  passing  from  the  internal  edge  of  the  cap- 
sular  ligament,  towards  the  head  of  the  bone  :  these  slips 
Jiave  been  called  Retinacula,—  <-but  they  are  of  no  importance. 

TABLE  OF  THE  LIGAMENTS  OF  THE  HIP  JOINT. 
1.  Ligamentum  Capsulare. 


3 

/I 

,   Terr? 

5            ,  , 

6.  - 

The  ligaments  eomseetiag  the  femur,  tibia,  and  patella  to- 
gether, are  very  uurrjer.ous  ;  for  though  the  motions  of  the 
knee  joint  are  veyy  &ifi?plfe,  being  merely  flexion  and  exten- 
sion, still  many  ligaments  are  necessary,  as  the  form  of  the 
bones  is  not  at  all  adapted  to  restrain  the  joint  from  being 
-either  too  much  bent,  or  too  much  extended  ;  but  many  of 
the  ligaments  which  are  enumerated,  are  so  trifling,  that 
they  cannot  be  considered  as  in  any  way  adding  "to  the 
strength  of  the  joint. 

The  first  ligament  to  be  dissected  in  this  joint,  as  in  almost 
M!!  others,  is  the  Capsulare.  It  is  in  itself  very  thin;  but  it: 


124 

is  strengthened  by  tendons  and  ligaments,  particularly  on 
f  lie  fore  and  back  part.  There  is  only  one  distinct  ligament 
On  the  inner  side  of  the  knee,  which  from  its  situation,  is 
called  the  Ligamentum  Lctic.rale  Intemum;  but  on  the  out- 
side, two  lateral  ligaments  are  described,  viz.  Long-urn  and 
Breve.  There  is  no  difficulty  in  finding  the  Longum^  but  the 
Breve  is  very  indistinct,  being  little  more  than  some  scatter- 
ed fibres,  which  run  from  the  outer  condyle  to  the  tibia. 
When  we  examine  the  posterior  part  of  the  joint,  we  shall 
find  a  complicated  set  of  ligaments  running  between  the 
tibia  and  femur.  •  They  are  sometimes  described  separately ; 
but  they  are  more  generally  classed  together,  under  the 
name  of  Ligamentum  Poplitale,  or  Ligamentum  Posticum 
Winslowii.  The  tendon  which  is  between  the  patella  and 
the  tubercle  of  the  tibia,  is  sometimes  described  as  a  liga- 
ment, and  is  called  Ligamentum  PateUce. 

These  ligaments,  which  are  all  external  to  the  capsular 
ligament,  may  be  each  considered  as  important.  We  should 
now  examine  those  which  appear  to  be  internal  to  the  cap- 
sular ligament.  They  are  very  numerous ;  but  of  the  whole, 
f  here  are  only  two,  which  can  be  considered  of  much  impor- 
tance, viz.  the  two  crucial  ligaments, — but,  by  a  nice  disssec- 
tion,  these  may  be  proved  to  be  also  external  to  the  capsular 
ligament.  To  show  the  internal  ligaments,  we  should  cut 
through  the  capsular  ligament,  beginning  at  the  upper 
part.*  As  the  cut  is  carried  past  the  patella,  a  duplicature, 
or  tucking  in  of  the  ligament,  will  be  seen  on  each  side ;  the 
one  on  the  outside,  is  called  the  Ligamentum  Jllare  Exter- 
num,  theother,  the  Ligamentum  Jllare  Internum.  When  we 
cut  through  these  portions  of  the  capsular  ligament,  and  pull 
down  the  patella,  we  shall  see  a  ligamentous  band  running 
towards  the  fatty  matter  which  lies  between  the  condyles  : 
this  is  the  Ligamentum  Mucosum.  When  this  is  cut  through  . 
or  broken,  the  Anterior  Crucial  Ligament  will  be  seen ;  but 
to  make  it  more  distinct,  we  should  cut  through  the  lateral 
ligaments,  and  the  ligamentum  poplitale, — we  shall  then 
find,  that  although  all  the  external  ligaments  are  cut,  that 
the  femur  and  the  tibia  shall  keep  their  relative  position  to 
each  other.  If  we  bend  the  femur  to  the  utmost  on  the 
tibia,  the  Anterior  crucial  ligament  will  be  distinctly  seen : 
if  we  extend  it  fully,  then  the  Posterior  will  be  stretched  : — 
and  if  we  twist  the  femur  on  the  tibia,  we  shall  comprehend 
why  these  ligaments  are  called  Crucial.  On  cutting  through 

*  In  cutting  through  the  insertion  of  the  muscles,  to  the 
patella,  we  shall  open  a  large  bursa,  which  is  often  connected 
with  the  capsular  ligament* 


125 

these  two  ligaments,'  the  femur  will  fall,  separated  from  the 
tibia.  We  have  now  finished  the  examination  of  the  liga- 
ments which  unite  the  femur  with  the  bones  of  the  leg  ;  but 
there  are  still  some  ligaments  on  the  head  of  the  tibia,  which 
form  part  of  the  apparatus  of  the  joint. 

The  Semilunar  Cartilages,  which,  by  their  peculiar  form. 
deepen  the  concavity  for  the  lodgement  of  the  condyles,  will 
be  seen  lying  on  the  upper  part  of  the  tibia.  If  we  put  the 
handle  of  the  knife  under  them,  and  push  it  towards  the  edge 
of  the  tibia,  the  ligament  which  is  called  Coronarivm,  and 
which  attaches  the  cartilages  to  the  rim  of  the  tibia,  will  be 
—  (there  is  only  one  described  for  both  cartilages.)  If 
we  look  on  the  anterior  part,  between  the  cartilages,  wt< 
shall  see  the  ligament  which  is  called  Transversale  ;  and 
lastly,  */e  may  observe,  that  the  extremities  of  the  two  car- 
tilages are  attached  to  the  tibia  by  separate  ligaments,  each 
of  which  is  called  OMV/v?. 

The  ligaments  which  are  generally  enumerated,  ?re  :  — 
(EXTERNALLY.) 

1.  Ligamentum  Capmtare. 
o.  _  --  Patellcc. 

3.  --  Lot  era!  e  Extcrnvm  Lonvvnt 

4.  J  ---  ,  -----  ,  --    B 


lute,  mum  . 


PopHtale. 


(INTF.RNALLY.J 

I.  LigatnentiiYn  A  lare  Externum* 
9.  --  Inter  num.. 
3.  - 


Cruciate  Antic-urn. 
Posticum. 


(When  the  bones  are  separated,) 
Coronurinm. 


7.  _  -  Tran.wersale. 

8.  9.   10.   li.   The  four  Oblique. 

When  we  remove  the  muscles  of  the  leg,  we  shall  find. 
that  the  tibia  and  fibula  are  bound  very  strongly  together  by 
the  Interosseous  Ligament;  but  at  the  upper  and*  lower  heads. 
we  shall  also  find  regular  capsules,  and  strengthening  liga- 
ments. At  the  upper  head,  there  are  two  accessory  liga- 
jnents,  one  of  which  is  on  the  fore  part,  the  other  behind  ; 
they  are  called  Ligamentum  Capititlct  FibuJce  Jlnticum  cr 
jAgamentum  Capitulce  Fibulw  Posticum;  at  the  Ipwer  head. 
they  also  receive  similar  names  :  but  Ve  may  remark,  that 
ki  consequenqe  of  the  inferior  ligaments  being  tfivicted  by 


126 

membrane,  and  vessels,  which  pass  through  the  mid- 
dle of  them,  some  authors  have  been  induced  to  describe  two 
before,  and  two  behind, — thus  there  would  be  a  Ligamentwti 
Jlnticum  Superius^  and  Ligameniicum  Jlnticum  Inferius, — and 
on  the  back  part,  Ligamentum  Posticum  Superius,  and  Lig(t~ 
•tn.-en.tum  Posticum  Inferius. 

As  the  ankle  joint  is  nearly  a  simple  hinge  joint,  thf 
principal  ligaments  must  be  lateral;  but,  as  in  this  joint,  the 
form  of  the  bones  is  not  very  well  adapted  for  checking  its 
motions  of  flexion  and  extension,  there  is  a  necessity  for 
more  ligaments,  than  those  merely  for  the  purpose  of  lateral 
motion.  The  ligamenturn  capsulare  is  very  thin  in  this 
joint,  but  it  is  strengthened  by  the  ligamentous  bands  which 
keep  the  tendons  of  the' muscles  in  their  proper  petitions  ; 
but  both  these,  and  the  capsular  ligament,  must  be  removed, 
before  we  can  see  the  proper  ligaments.  We  shall  then 
find,  on  the  ir,side  of  the  joint,  a  very  strong  ligament  run- 
ning from  the  point  of  the  tibia  to  the  astragalus  and  navicu- 
lare  ;  this  ligament  from  its  shape,  is  called  Deltoides,  or 
Triangulare.  From  the  tip  of  the  fibula,  three  portions  of 
ligament  will  be  seen  to  pass  off;  one  runs  perpendicularly 
from  the  middle  part,  to  the  os  calcis,  whence  it  has  receiv- 
ed the  name  of  Perpendiculare,  or  ^Medium ;  anothef  runs  to 
the  anterior  part  of  the  astragalus,  and  is  called  Ligamentum 
inter  Fihulam  et  Astra galum  Anlwum;  while  the  third  passes 
from  the  back  of  the  fibula  to  the  posterior  part  of  the  astra- 
galus, and  this  is  also  named,  according  to  its  situation  and 
course, {  Ligamentum  inter  Fibvlam  et  Jlstragalum  Posticum, 
Roth  of  these  ligaments  may  occasionally  be  divided  into  two 
portions;  but  they  are  not  named  differently  on  that  account. 

LIGAMENTS  BETWEEN  THE  TIBIA  AND  FIBULA. 

(ON  THE  UPPER  PAR.T.) 

L  Ligamentum  Capsulare. 

2. CapitulcK  Fibulae  Antintm. 

3. ____ __.  Postic-wn . 

\. Interosseum. 

(AT  THE  LOWER  PART.) 

1 .  Ligamentwn  Aniicum  Superius. 

2.  ' Inferiufi. 

3. Posticum  Sup 

4, *    •    •." 


127 

LIGAMENTS  BETWEEN  THE  TIBIA,  FIBULA. 
AND  BONES  OF  THE  TARSUS. 

1.  Ligament-urn  Capwlare. 

2. —  Deltoid es,  or  Triangulare. 

3. Perpendiculare. 

4. Inter  Fibulam  et  Astragalum  Aniicuin. 

5.  — • Posticum. 

The  ligaments  which  connect  the  bones  of  the  foot  to- 
gether, rnay  be  exposed  by  removing  the  tendons  of  the  mus- 
cles. The  ligaments  are  very  numerous,  but  not  of  much 
importance.  The  names  which  are  given  to  them,  are  gen- 
erally descriptive  of  the  bones  between  which  they  run,  and 
the  direction  their  fibres  take. 

Upon  the  upper  part  of  the  foot,  there  are  no  ligaments 
which  we  would  particularly  notice.  They  are  called  Liga- 
menta  Dorsalia,  with  the  addition  of  the  names  of  the  bones 
between  which  they  run,  and  the  terms  Recta,  Obliqua,  &c. 
In  the  middle  of  the  sole  of  the  foot,  the  bands  are  so  nu- 
merous, that  we  never  think  of  particularizing  them;  but  on 
the  inner  and  outer  part,  the  ligaments  are  more  distinct. 
On  tiie  inside,  a  strong  band  of  fibres  may  be  traced  from 
the  os  calcis  to  the  naviculare ;  in  the  upper  and  middle  part 
of  this,  a  cartilage,  somewhat  resembling  a  small  patella,  will 
be  found,  under  which  is  the  projecting  point  of  the  astraga- 
lus :  this  portion  of  the  ligament  is  called  the  Trochlea  Car- 
niaginea,  the  other  part  being  called  the  Ligamentum  Plan- 
tare  MA  jus,  the  MINUS  being  a  more  internal  portion  of  the 
same  band.  On  the  outside  of  the  foot,  we  shall  find  a  very 
strong  ligament  passing  from  the  os  calcis  to'theos  cuboides; 
this  is  also,  by  Weitbrecht,  divided  into  two  ligaments,  viz. 
Ligamentum  inter  Os  Calcis  et  Cuboides  LONGUM,  and  Lig  : 
BREVE. 

It  is  quite  needless  to  enumerate  the  small  ligaments 
which  bind  the  metatarsal  bones  together. 

The  phalanges  of  the  toes  are  connected  together  by  strong 
CAPSULAR  and  LATERAL  ligaments,  as  the  joints  permit  only 
of  FLEXION  and  EXTENSION. 

The  student  will  naturally  direct  his  attention  to  the 
question  of  Dislocation  and  Fracture  of  the  several  bones, 
while  the  parts  are  before  him.  I  cannot  enter  upon  the 
subject,  but  must  refer  him  to  the  essays  by  Mr.  A.  Cooper, 
and  the  system  of  Operative  Surgery  by  Mr.  Charles  Bell, 
where  he  will  find  plans  illustrative  of  the  several  dislocations 
and  fractures. 


128 

DISSECTION 

OF  THE 

ARTERIES  OF  THE  LOWER  EXTREMITY. 


As  the  object  of  the  student,  in  his  first  dissection  of  the 
arteries,  should  be,  to  learn  the  course  of  the  trunks,  and 
their  principal  branches, — the  limb  ought  to  be  injected. 

If  the  subject  be  young-,  the  injection  of  the  arteries  of 
both  legs  may  be  made  at  once  from  the  aorta;  but  if  the 
body  be  old,  it  will  be  necessary  to  inject  each  limb  sepa*- 
ratelv,  because,  in  such  a  subject,  we  shall  seldom  succeed  in 
pushing  the  injection  from  the  aorta  to  the  extremities  of  the 
arteries.  But  if  both  limbs  be  injected  from  their  corres- 
ponding iliac  arteries,  the  middle  sacral  artery  will  be  lost. 
This,  however,  may  also  be  filled,  if  the  right  leg  be  injected 
from  the  aorta,  the  left  iliac  having  been  tied  immediately 
below  the  point  of  bifurcation.  The  other  leg  may  be  after- 
wards injected  by  putting  a  pipe  into  the  iliac,  below  the 
point  where  it  was  tied. 

As  the  dissection  of  the  arteries  of  the  leg  is  very  tedious, 
we  should  not  spend  much  time  in  examining  the  abdominal 
muscles.  We  should  merely  dissect  the  inguinal  canal,  and 
then  cut  through  the  muscles  below  the  umbilicus.  The 
viscera  should  also  be  removed. 

The  arteries  of  the  pelvis  should  be  dissected  before  those 
of  the  thigh ;  because  the  parts  in  the  pelvis  very  quickly  be- 
come putrid,  and  when  in  this  state,  if  there  be  any  had  in 
the  composition  forming  the  injection,  the  vessels  will  ap- 
pear of  a  black  colour. 

There  are  very  few  directions  necessary  to  be  given  for 
the  dissection  of  arteries  that  have  been  injected.  They  are 
to  be  traced  from  trunk  to  branch :  and  to  do  this,  it  is  only 
requisite  to  raise  the  cellular  membrane,  &c.  with  the  for- 
ceps and  scissors. 

But  before  the  student  commences  the  dissection  of  the 
arteries,  he  ought  to  consider  what  are  the  most  important 
parts  of  that  division  of  the  body,  which  he  is  about  to  exa- 
mine. This  will  assist  him  very  much  in  learning  the  distri- 
bution of  the  arteries,  for  he  will  find  that  the  number  of 
branches  will  very  nearly  correspond  with  the  number  of  the 
more  important  parts.  He  will  find,  for  example,  that  the 


129 

arteries'which  go  off  from  the  lower  part  of  the  aorta  may  be 
divided  into  three  classes : 

1.  The  arteries  which  pass  down  to  supply  the  thigh  and 
leg. 

2.  Those  which  supply  the  muscles  on  the  pelvis. 

3.  The  branches  which  are  distributed  to  the  viscera  of 
the  pelvis. 

Those  which  pass  to  the  thigh  and  leg  will  be  afterwards 
subdivided.  I  shall  now  proceed  to  describe  the  manner  in 
which  those  that  supply  the  pelvis  are  to  be  traced. 

After  the  cellular  membrane  and  peritoneum  are  removed 
from  the  Aorta,  it  will  be  seen  to  divide  into  two  great 
branches,  viz.  the  Common  Iliacs.  From  the  point  of  bifur- 
cation there  is  likewise  a  small  vessel  passing  off',  which  is 
called  the  Sacra  Media. 

The  Common  Iliac  of  either  side  may  be  very  easily  expo- 
sed, for  there  are  seldom  any  branches  given  off  by  it :  if 
there  be  one,  it  will  probably  be  that  which  passes  between 
the  vertebra?  and  the  ilium,  and  is  called  the  ilio  lumbalis. 
But  this  artery  more  generally  rises  from  the  internal  iliac. 

If  we  trace  the  common  iliac  for  about  an  inch  and  a  half, 
we  shall  find  it  divided  into  two  branches, — the  External  and 
Internal  Iliacs.  The  external  iliac  is  the  vessel  which  sup- 
plies the  branches  of  the  first  class  enumerated;  but  at 
present  we  should  not  trace  it  farther  than  to  the  ligament 
of  Poupart. 

We  may  now  return  to  the  internal  iliac,  from  which  the 
two  next  classes  of  branches  are  given  off.  These  are  par- 
ticularly difficult  to  trace  ;  and  were  we  not  to  recollect  that 
they  formed  two  distinct  classes,  it  would  be  difficult  to  un- 
derstand them. 

The  trunk,  after  leaving  the  common  iliac,  is  almost  con- 
cealed by  the  great  veins ;  but  these  may  be  cut  away,  be- 
cause, in  the  present  dissection,  every  thing  should  be  re- 
moved that  impedes  our  view  of  the  arteries.  The  first 
branch  that  is  seen,  will  probably  be  that  which  has  been 
already  described  as  coming  occasionally  from  the  common 
iliac,  viz.  the  ilio  lumbalis.  If  the  subject  be  very  young, 
we  shall  find  that  the  trunk  of  the  internal  iliac  is  continued 
up  on  the  side  of  the  bladder,  and  then  becomes  a  ligamen- 
tous  cord,  which  may  be  traced  towards  the  umbilicus ;  but 
in  the  adult,  or  old  subject,  we  shall  find  the  artery  stop 
rather  abruptly  before  it  reaches  the  bladder.  This  will  be 
explained  by  the  dissection  of  the  foetus,  for  there  we  shall 
find  that  the  internal  iliac  is  continued  to  the  umbilicus  as 
the  hypogastric  or  umbilical  artery,  the  upper  portion  of 


130 

which  gradually  degenerates  into  ligament  as  a  person  ad- 
vances in  years. 

In  the  adult,  small  branches,  which  are  called  vesicates  sit- 
periores,  are  sent  to  the  fundus  of  the  bladder,  from  the  ter- 
mination of  the  artery :  they  will  be  seen  more  distinctly  if 
the  bladder  be  distended.  If  we  hold  aside  the  bladder,  we 
shall  probably  see  certain  other  branches  passing  towards  its 
middle,  and  which  are  called  vesicates  medm.  These  come 
off  generally  from  the  artery,  just  as  it  is  turning  up  from  the 
trunk  of  the  internal  iliac;  but  they  are  very  irregular.  If 
we  now  pull  up  the  bladder,  and  separate  it  a  little  from  the 
rectum,  we  shall  see  branches  passing  towards  the  prostate 
and  the  vesiculse  seminales.  The  origin  of  these  cannot  be 
seen  at  present,  as  they  generally  arise  from  the  pudic.  A 
section  of  the  pelvis,  such  as  has  been  described  at  page  80, 
must  be  made,  before  we  can  trace  these  branches,  or  the 
continued  trunk  of  the  iliac. 

After  having  made  the  section,  and  partially  distended  the 
bladder  with  air,  the  dissection  of  the  internal  iliac  may  be 
resumed.  The  branches  of  this  artery  are  so  irregular  in 
their  manner  of  coming1  off,  that  we  should  trace  them  for 
some  distance  before  we  attempt  to  name  them.  If  we 
should  rind  one  going  towards  the  obturator  muscle,  it  will 
be  the  Obturator ;  and  if  we  see  another  large  artery  passing 
down  towards  the  outlet  of  the  pelvis,  and  dividing  into  two 
ferajiches,  it  will  probably  be  the  common  trunk  of  the  Is- 
chiatic  and  Pudic.  The  large  vessel  which  runs  in  the  angle 
between  the  sacrum  and  the  ilium,  and  appears  like  the  con- 
tinued trunk  of  the  iliac,  will  be  the  Gluteal.  But  the  ves- 
sels do  not  always  come  off  in  this  order.  The  most  irregu- 
lar is  the  obturator;  for  it  frequently  rises  from  the  external 
iliac,  in  union  with  the  epigastric. 

In  dissecting  these  branches,  it  will  be  most  Convenient  to 
begin  with  the  obturator.  This  maybe  very  quickly  traced ; 
and  having  finished  it,  the  pudic  may  be  next  followed. 
There  is  some  difficulty  in  dissecting  the  first  set  of  arteries 
which  the  pudic  gives  off,  for  they  supply  the  viscera  of  the 
pelvis,  and  are  united  with  the  branches  of  the  inferior  me- 
Fcnteric.  In  the  male,  we  shall  find  branches  passing  to  the 
middle  of  the  bladder  (vesicates  mediae,)  to  the  rectum  (/<#?- 
morrhoidales,)  and  to  the  lower  part  of  the  bladder  (vesicates 
imae.)  But  in  the  female  we  shall  find,  besides  these,  a  very 
large  artery  passing  to  the  wterus  (the  utcrina.)  We  may 
now  trace  the  trunk  to  the  space  between  the  sacro  ischiatic 
ligaments.  While  here,  it  gives  off  some  muscular  branches, 
but  it  almost  immediately  passes  again  into  the  pelvis,  and  iy 
then  distributed  to  the  parts  in  the  perineum,  in  the  manner 


131 

described  at  page  78.  This  description  will  suffice  for  only 
one  side  of  the  pelvis ;  for  in  the  other  the  small  branches 
must  have  been  cut  across  in  removing  the  viscera. 

As  the  Ischiatic  comes  as  often  from  the  gluteal  as  from 
the  pudic,  it  is  difficult  to  describe  the  irregular  branches 
which  pass  from  it  while  it  is  within  the  pelvis.  But  they 
are  generally  of  little  importance,  for  the  artery  will  be  found 
to  pass  out  of  the  pelvis,  very  little  diminished  in  size,  to 
supply  the  muscles  of  the  hip,  in  the  manner  described  in  the 
table. 

In  tracing  the  Ghdeal  while  yet  within  the  pelvis,  we  shall 
find  a  set  of  arteries  passing  off  from  it  to  the  lateral  parts  of 
the  sacrum,  viz.  sacrce  laterales.  These  vessels  sometimes 
arise  in  one  common  trunk,  but  more  generally  in  three  or 
four  distinct  branches,  each  of  which  inosculates  with  the 
sacra  media,  in  its  course  along  the  middle  of  the  sacrum. 

Before  we  can  trace  the  external  branches  of  the  gluteal 
and  ischiatic,  we  must  make  a  superficial  dissection  of  the 
muscles  of  the  hip.  If  our  object  were  to  keep  the  arteries 
after  they  are  dissected,  we  ought  to  preserve  all  the  branches 
which  go  to  these  muscles ;  but  as  at  present  we  wish  only 
to  acquire  a  general  knowledge  of  the  vessels,  we  should  not 
attempt  to  dissect  all  the  smali  muscular  twigs. 

We  should,  therefore,  make  such  a  dissection  of  the  mus- 
cles of  the  hip  as  is  described  in  page  102  •  in  doing  this,  some 
small  arteries  passing  to  the  skin,  and  ramifying  upon  the 
fascia  of  the  gluteus  medius,  will  be  seen.  In  separating 
the  gluteus  maximus  from  the  gluteus  medius,  we  shall  be 
obliged  to  cut  a  large  branch,— the  superjkialis,  which  passes 
into  the  substance  of  the  gluteus  maximus.  If  we  then  raise 
the  gluteus  medius,  we  shall  discover  an  artery  passing  under 
it,  and  dividing  into  two  branches,  which  are  called  Asccn- 
dens  and  T-ransversalis.  At  this  stage  of  the  dissection,  we 
shall  also  see  some  of  the  branches  of  the  ischiatic  artery 
forming  inosculations  with  those  of  the  gluteal,  and  with  tl.V 
branches  from  the  pudic ;  but  the  principal  branches  of  the 
ischiatic  will  be  afterwards  seen  passing  over  the  small  mus- 
cles, along  with  the  great  nerve,  to  form  inosculations  with 
the  branches  of  the  external  iliac. 

We  may  now  return  to  the  dissection  of  the  External 
Iliac,  which  has  been  already  traced  as  far  as  the  edge  of  thp 
Poupart  ligament.  If  we  hold  up  the  flap  of  the  abdominal 
muscles,  and  strip  the  peritoneum  from  it,  we  shall  see  the 
first  branch,  the  Epigastric,  passing  from  the  trunk  towards 
the  rectus  muscle ;  the  next,  Circumflexa  //«',  rises  about 
half  an  inch  below  the  epigastric,  and  on  the  iliac  edge  of 
the  artery  ;  but  the  Obturator  will  be  also  found  coining'  from 


132 

the  external  iliac,  in  union  with  the  epigastric,  in  the  propor- 
tion of  one  in  four  to  the  number  of  times  which  it  rises  from 
the  internal  iliac.  The  main  artery,  after  giving  off  these 
branches,  passes  under  the  ligament  of  Poupart :  and  here, 
instead  of  the  name  of  "  external  iliac,"  it  receives  that  of 
Inguinal,  or  Common  Femoral. 

We  shall  find  the  arrangement  of  the  branches  which  are 
given  off  from  this  artery  before  it  becomes  popliteal,  to  be 
very  simple  ;  for  there  is  only  one  series  of  branches  to  sup- 
ply the  great  muscles,  and  another  to  encircle  the  joints  and 
to  form  inosculations  with  the  other  arteries.  The  branches 
which  supply  the  muscles,  are  either  called  Perforantes  or 
Jlluscular ;  while  those  which  surround  the  joints  are  called 
Circwnflexct)  Articular,  Recurrent,  or  AnaMomotic.  But,  in 
making  this  arrangement,  we  must,  at  the  same  time,  recol- 
lect, that  the  vessel  which  is  passing  to  supply  the  parts  be- 
low the  knee,  is  the  principal  artery  in  the  thigh. 

The  dissection  is  not  to  be  begun  in  the  same  manner  as 
that  for  the  muscles  : — the  skin  only  is  to  be  carefully  remo- 
ved from  the  groin,  and  then  some  small  arteries  will  be 
seen  passing  into  the  glands  of  the  groin,  to  the  scrotum,  to 
the  skin  of  the  penis,  arid  to  the  superficial  parts  of  the  ab- 
dominal muscles.  Those  going  to  the  glands  are  called  In- 
guinales ;  those  to  the  skin  of  the  penis  and  scrotum,  Puden- 
dce  Externce ;  and  those  which  pass  back  to  the  abdominal 
muscles,  Epigastrica  Superficiaiis  and  Reflexa  Ilii.  Thesp 
small  vessels  are  then  to  be  h'eld  aside,  and  the  trunk  is  to  be 
exposed  by  removing  the  cellular  membrane  with  the  forceps 
and  scissors.  The  artery  will  be  found  lying  upon  the  psoas 
muscle,  with  the  great  vein  on  its  pubic  side.  The  anterior 
•crural  nerve  lies  upon  the  iliac  side  of  the  artery,  but  not 
close  upon  it. 

There  is  here  much  difficult  dissection,  and  the  only  rule  that 
can  be  given  for  conducting  it,  is  to  trace  the  trunk  very 
cautiously  with  the  forceps  and  scissors,  tor  large  branches 
will  be  found  passing  off  from  each  side  of  it,  and  principally 
from  its  iliac  side  :  these  branches  are  intimately  connected 
with  those  of  the  great  vein  and  the  anterior  crural  nerve, 
which,  however,  in  this  first  dissection,  may  be  all  removed. 
The  order  in  which  the  great  branches  arise,  is  so  very 
irregular,  that  it  is  absolutely  necessary  here,  as  in  many 
other  parts  of  the  body,  to  name  the  branches  according  to 
the  parts  to  which  they  are  going, — not  by  the  order  of  their 
coming  off  from  the  main  trunk. 

At  about  two  inches  from  the  edge  of  Poupart's  ligament, 
we  shall  probably  find  the  great  artery  dividing  into  two  large 
branches.  The  one,  which  passes  deep,  and  rather  to  the 


133 

out  side,  is  the  vessel  which  generally  gives  off  the  principal 
branches  to  the  thigh ;  it  is  called  the  Proper  Femoral,  or  the 
Profunda.  The  other  is  the  continued  trunk  of  the  Femoral 
which,  after  giving  off  a  very  few  branches,  passes  into  the 
ham,  and  there  divides  into  the  arteries,  for  the  supply  of  the 
parts  below  the  knee. 

The  dissection  of  the  superficial  artery  should  be  made 
first.  It  may  be  traced  as  far  .down  as  the  part  where  it  per- 
forates the  tendon  of  the  adductor  magnus  :  in  this  course 
there  are  only  some  small  branches  given  to  the  muscles 
which  are  close  to  it ;  but  while  it  is  perforating  the  tendon 
of  the  triceps,  it  gives  off  an  artery,  which,  though  not  large, 
is  very  important  in  a  surgical  view, — the  Anastomoticus  Mag- 
nun. 

We  may  now  return  to  the  dissection  of  the  branches  of 
the  Prof  iinda.  And  here  I  can  only  repeat,  that  to  expo.se 
these  branches,  we  must  remove  the  parts  that  are  closely 
connected  to  them,  with  the  forceps  and  scissors.  The 
two  first  arteries  which  we  should  look  for,  are  the  Circwn-- 
Jiexa  Externa  and  Circumflexa  Interna.  The  first  will  be  ge 
nerally  found  going  off  from  the  upper  and  outer  part  of  the 
profunda,  or  from  the  main  trunk,  immediately  before  it  di- 
vides ;  it  then  passes  under  the  rectus  muscles,  towards  the 
outside  of  the  hip  :  while  passing  under  the  rectus,  it  gene- 
rally gives  off  a  branch  which  runs  along  the  vastus  externus 
to  the  outside  of  the  knee, — this  is  the  Ramus  Externus  De- 
xcendens  Longus.  The  internal  circumflex  passes  off  opposite 
to  this,  and  immediately  dips  under  the  pectinalis,  to  supply 
the  heads  of  the  deep  muscles  at  the  joint,  and  to  inosculate 
with  the  branches  of  the  obturator  artery.  This  is  more  pro- 
perly the  artery  of  the  joint  than  the  external  circumflex. 
The  branches  of  the  profunda,  which  are  called  Perforantes* 
and  that  may  now  be  traced  towards  the  insertions  of  the  tri- 
ceps, through  which  they  pass  to  the  muscles  on  the  back  of 
the  thigh,  are,  in  number,  three,  four,  or  five.  But  before 
we  can  see  them  distinctly,  we  must  make  a  careful  dissec- 
tion of  these  muscles,  and  then  many  branches  will  be  found 
going  to  inosculate  with  the  gluteal  and  ischiatic  arteries,  and 
also  with  the  two  circumflex. 

The  dissection  of  the  two  ham-string  muscles  should  now 
be  continued  down  to  the  knee.  Very  few  arteries  will  be 
seen  in  the  superficial  dissection  ;  for  the  branches  are  bu- 
ried in  the  fat  which  lies  between  the  muscles ;  but  if,  in 
looking  for  the  trunk,  we  dissect  deeply  the  edge  of  the  bi- 
ceps and  semitendinosus,  we  shall  be  very  apt  to  cut  some  of 
the  lateral  branches.  This  may  be  avoided,  by  commencing 
the  dissection  in  the  middle  of  the  ham  ;  for  after  raising-  J 
M 


134 

very  little  cellular  membrane,  we  shall  expose  the  great 
nerve  ;  and  then,  by  drawing"  it  aside,  or  cutting'  it  through. 
we  shall,  at  about  half  an  inch  cleeper,  find  the  vein,— and  im- 
mediately under  it,  and  close  upon  the  bone,  the  continued 
trunk  of  the  femoral  artery,  which  is  now  called  Pnptif.eaf.  1  f 
we  now  remove  the  fat,  &c.  from  .the  artery  as  far  up  as  the 
point  where  it  perforates  the  triceps,  and  as  far  down  as  we 
can,  without  cutting-  through  the  gastroenemrue  muscle,  \\r 
shall  discover  a  very  regular  series  of  branches  : — from  the 
upper  part  ot  the  artery,  there  are  several  sent  back  to  inos- 
culate with  the  perforantes,  the  principal  one  of  which  is 
Rnmus  Profundus  Popliteal  ; — from  the  lower'*  part,  two  or 
three  arteries,  which  are  called  Swales,  pass  to  supply  the, 
gastrocnemius  and  soleus.  The  intermediate  branches  are** 
called  Articular,  as  they  encircle  the  knee  joint  :  two  of  thesf 
pass  towards  the  inner  condole,  and  are  thence  named  Arti- 
cularis  Superior  Internet,  and  Atiicv.iaris  Inferior  Infema,. 
The  two  which  arise  on  the  outer  edge  of  the  artery,  are  cal- 
led Articularis  Superior  Extema  and  Arlicularis  Jnfe.riorJ-.s~ 
terna  ;  but  there  is  still  a  fifth  articular  artery,  which  passes 
through  the  ligamentum  posticum  Winslowii,  and  supplies 
the  inner  part  of  the  joint,  and  is  called,  from  its  being  a 
single  branch,  JLrticularis  Azyga,  or  JMctfa. 

We  must  now  separate  trie  origin  of  the  gastrocnemius 
from  the  coridyles,  and  the  origin  of  the  soleus  frcm  the  tibia, 
in  order  to  show  the  Popliteal  dividing  into  the  •Anterior  and 
Posterior  Tibial  Arteries. 

We  shall  see  only  a  small  part  of  the  Anterior  Tibial,  for 
it  almost  immediately  passes  through  the  interosseus  liga- 
ment; but  by  raising  the  fascia  which  covers  the  deep  layer 
of  muscles,  we  shall  see  the  Posterior  Tibia!,  through  almost 
its  whole  course.  This  artery  generally  gives  off  the  Pe.ro* 
neal,  or  Fibular  Artery,  about  half  an  inch,  or  an  inch,  be- 
low the  edge  of  the  popliteus  muscle.  But  the  fibular  is  ve- 
jry  irregular;  indeed  it  is  described,  by  many,  as  rising  more 
frequently  from  the  anterior,  than  the  posterior  tibial.  While 
the  posterior  tibia!  is  passing  the  insertion  of  the  popliteal 
muscle,  it  gives  off  a  branch,  which,  passing  into  the  bone,  is 
called  the  Nutritia  Tibiae.  The  artery  may  then  be  traced. 
under  the  fascia,  to  below  the  inner  ankle,  without  our  see- 
ing any  branch  of  importance ;  but  here  it  senxis  some  branch- 
es to  the  heel,  which  are  called  Calcanece>  and  then  divides 
into  the  Plantaris  Externa  and  Plantaris  Internet, — which 
arc  to  be  carefully  traced  between  the  muscles  in  the  sole  of 
the  foot  :  in  doing  this,  we  shall  be  obliged  to  cut  many  of- 
the  muscles.  The  plantar  arteries  will  be  seen  to  form  mos- 


135 

euications  with  those  branches  of  the  anterior  tibial,  which 
perforate  the  spaces  between  the  metatarsal  bon^s. 

We  should  now  return  to  the  dissection  of  the  ,  ..riches  of 
the  Fibular  Artery.  This  vessel  is  not  only  very  irregular 
in  its  origin,  but  also  in  its  size  ;  for  it  always  depends  upon 
the  magnitude  of  the  anterior  and  posterior  tibial  arteries. 
In  its  course  towards  the  ankle,  it  gives  off  small  branches 
t»  the  muscles  rising  from  the  fibula, — one  to  the  bone  itself; 
and  when  about  four  inches  from  the  ankle,  it  will  be  found 
to  divide  into  two  branches,  which  are  called  Anterior  Fibu- 
lar and  Posterior  Fibular.  The  anterior  inosculates  with 
the  branches  from  the  Tamea-l  of  the  anterior  tibial,  while 
the  posterior  inosculates  with  the  Calcancas  of  the  posterior 
tibial. 

We  may  now  make  the  dissection  of  the  Anterior  Tibial. 
To  rind  it,  we  should  Hret  expose  the  muscles  on  the  fore 
part.  In  doing  this,  we  shall  see  the  recur  win  passing  back 
upon  the  knee  ;  then,  by  dissecting  between  the  tibialis  anti- 
i-.us  and  extensor  coimnutiis  digitorum,  we  shall  discover  the 
mum  artery  lying  close  upon  the  interosseous  ligament.  It 
may  then  be  easily  traced  to  the  great  toe,  giving  off  branch- 
es in  its  course,  the  names  of  which  are  descriptive  of  the 
parts  which  they  supply. 

The  manner  of  dissecting  the  arteries,  which  has  just  been 
described,  should  be  nearly,  followed  in  making  a  prepara- 
tion ;  but  the  dissection  should  be  prosecuted  in  a  very  dif- 
ferent manner,  in  studying  the  surgical  anatomy  ;  but  that 
I  shall  not  describe  until  the  dissection  of  the  nerves  is  fin- 
ished. 

VEINS  OF  THE  LOWER  EXTREMITY. 

The  deep  veins  of  the  lower  extremity  are  so  easily  under- 
stood, 1  >u-it  it  is  not  necessary  to  make  a  separate  dissection, 
nor  even  to  inject  them,  to  enable  us  to  trace,  them.  The 
Superficial  Veuis^  which  are  the  most  important,  are  describ- 
ed with  the  cutaneous  nerves.  With  regard  to  the  deep 
veins,  ur  cena  cowef.es,  it  is  only  necessary  to  say,  that  they 
accompany  the  arteries,  and  are  named  according  to  them. 
\Ve  shall  find  that  many  of  the  arteries  have  a  vena  comes 
a'Ji  bide. 


136 

TABLE  OF  THE  ARTERIES  OF  THE  PELVIS,  OF 
THE  THIGH,  AND  OF  THE  LEG  AND  FOOT. 

ARTERIES    OF    THE    PELVIS. 

'UACA    COMMUMS,  into  the  ILIACA    INTERNA  and  1LIACA  EX- 
TERNA. 

Iliaca  Internet,  gives  off. 

1.  ILIO  LUMBALIS  ;  to  supply  the  Iliacus  Internus  and 

Psoas  Magnus. 

II.  SACRJE  LATERALES  ;  three  or  four  in  number,  to  the 
lateral  part  of  the  sacrum. 

III.  UMBILICALIS,  or  HYPOGASTRICA  ;  gives  off  branches 
to  the  upper  part  of  the  bladder,  viz.  Vesicales  Supe- 
riores. 

IV.  OBTURATOR; — 1.  within  the  pelvis,  muscular  branch- 
es to  the  psoas  and  obturator  interims ;  2.  a  branch 
to  the  back  of  the  pubes  ;  3.  in  the  thigh,  branches  to 
the  obturator  externus,  pectinalis,  and  triceps. 

V.  GLUTEA  ;  passes  out  of  the  pelvis  over  the  edge  of  the 

pyriformis,  and  betwixt  two  of  the  roots  of  the  great 
ischiatic  nerve,  Within  the  pelvis,  1 .  muscular  branch- 
es— (sometimes  the  sacras  laterales) ;  after  it  passes 
out,  2.  Ramus  Superficial,  viz.  under  the  gluteus 
maximus  ;  3.  Ramus  Ascendens,  viz.  under  the  glu- 
teus medius  ;  4.  Ramus  Transversus,  viz.  under  the 
gluteus  meclius,  and  forward. 

VI.  ISCHIATICA  ; — within  the  pelvis,  and  in  its  passage  out, 
branches  to  the  bladder,  rectum,  and  neighboring 
muscles  ;  on  the  back  of  the  pelvis,  to  the  glutei,  to  the 
great  nerve,  to  the  lesser  muscles  of  the  thigh  bone, 
in  many  profuse  branches. 

VII.  Pubic  A  INTERNA; — before  it  passes  out  of  the  pelvis, 
it  gives  off,  1.  Ha}morrhoidales  Mediae;  2  Vesicales 
Ima3 ;  while  between  the  ligaments,  3.  to  the  gemini,  ob- 
turator, and  pyriformis  muscles ;  on  entering  the  pel- 
vis again,  4.  Ha3morrhoidales  Externa3:  in  the  perine- 
um, 5.  Superficial  Perinei ;  6.  Transversalis  Perin- 
ei ; — then  we  find  the  three  important  arteries  continued 
from  the  trunk,  (Jlrteria  Communis  Penis)   1.  Artery 
of  the  Bulb,  2.  Arteria  Profunda  Propria,  3.  Arteria 
Superficialis,  Dorsalis  Penis, 


137 

ARTERIES  OF  THE  THIGH. 

ILIACA  EXTERNA. 

(within  the  abdomen.) 

I.  IRREGULAR  BRANCHES  TO  THE  MUSCLES. 
II.   ARTERIA  EPIGASTRICA  :  1.  to  the  cord   and  crernasU-r 
muscle  ;  2.  towards  the  back  of  the  os  pubis  ;  3.  prin- 
cipal branch  ascending  upon  the  rectus  ;  4.  sometimes 
the  obturator. 

HI.  ARTERIA  CIRCUMFLEXA  ILLI;  to  the  iliacus  interims, 
to  the  abdominal  muscles,  anastomosing  with  the  ilio 
lumbalis,  and  often  a  branch  to  the  spermatic  cord. 

FEMORAL  ARTERY. 

1.  KAMI  IiNGurNALEs;  1.  to  the  glands,  fat,  and  integu- 
ments :  -2.  Ramus  Major,  sometimes  called  Reflexa 
Ilii ;  3.  Epigastrica  Superficialis, — but  this  is  very 
irregular. 

IE.  ARTERIJE  PTTDENDJE,  viz.  1.  pudenda  superior,  2.  pu- 
denda media,  3.  pudenda  inferior. 

HI.  CIRCUMFLEXA  EXTERNA  ; — (sometimes  from  the  femo- 
ral, but  most  commonly  from  the  profunda  ;)  1.  mus- 
cular branches ;  2.  transverse  branch  to  the  muscles, 
3.  the  proper  branch  to  the  joint  communicating  with 
the  circumflexa  interim ;  4.  Ramus  Externus  De- 
scendens,  passing  between  the  vastus  externus  and 
rectus,  arid  inosculating  with  the  articular  arteries  of 
the  knee. 

IV.  CIRCUMFLEXA  INTERN  A  : — (often  from  the  profunda  ;) 

1.  branches  to  the  triceps  ;  2.  branches  to  inosculate 
with  the  obturator  ;  3.  branches  to  the  capsule  of  the 
joint. 

V.  PROFUNDA  ;   1.  irregular  branches;  2.  great  descending 

internal  branch — 1 .  ramus  perforans  primus,  2.  ramus 
perforans  secundus,  3.  ramus  perforans  tertius,  and 
sometimes,  4.  ramus  perforans  quartus. 

SUPERFICIAL  FEMORAL  ARTERY. 

I1.  IRREGULAR  BRANCHES  TO  THE  MUSCLES  WHICH  IT  PAS- 
SES. 

It.  RAMUS  ANASTOMOTICUS  MAGNUS.  This  is  the  first 
considerable  branch  which  the  femoral  artery  gives 
*ff,  viz.  while  concealed  in  the  tendon  of  t 


138 


POPLITEAL  ARTERY. 

(Being  that  part  of  the  trunk  which  lies  in  the  cavity  freinnu 
the  knee  joint.) 

I.  RAMUS  PROFUNDUS  POPLITE^  :  to  the  ham-string  mus- 

cles, &c. 

II.  ARTERIA  ARTICULARIS  SUPERIOR  EXTERNA;  1.  Ramus 

Profundus ;  2.  Superficialis. 

III.  ARTERIA  ARTICULARIS  SUPERIOR  INTERNA  ;  1.  Ramus 

Profundus ;  2.  Superficialis. 

IV.  ARTERIA  ARTICULARIS  MEDIA.    A  branch  enters  under 

the  ligament  of  Winslo w. 

V.  ARTERIA  ARTICULARIS    INFERIOR  EXTERNA;  1.  to  the 

muscles  ;  2.  deep,  and  passing  above  the  head  of  the 
fibula. 

VI.  ARTERIA  ARTICULARIS  INFERIOR  INTERNA  ;  chiefly  su- 

perficial, and  beautifully  encircling  the  head  of  the  ti- 
bia. 

VII.  BRANCHES   TO  THE  GASTROCNEMII  MUSCLES,  viz.   THJ. 

SURALES. 

GREAT  DIVISION  of  the  POPLITEAL  ARTERY  into 
the  ANTERIOR  TIBIAL  ARTERY  and  the  POSTE- 
RIOR TIBIAL  ARTERY. 

ANTERIOR  TIBIAL  ARTERY. 

'Before  passing  betwixt  the  bones — 1 .  A  small  ascending  branch 

which  may  be  called  Articularis  Tibialis. 
&s  it  escapes  from  the  interosseous  ligament — 2.  Recurrens 

Tibialis. 
Upon  the  ligament — 3.  Successive  muscular  branches-    4, 

Malleolaris  Interna.     5.  Malleolaris  Externa. 

.Before  the  ankle — 6.  Tarsea.     7. interossea?. 

On  the  foot — 8.  Metatarsea.     Dorsales  Digitorum.  9.   Dor- 

salis  Halucis.     10.  RAMUS  PROFUNDUS  ANASTOMOTI- 

cus. 

POSTERIOR  TIBIAL  ARTERY. 

I.  MUSCULAR  BRANCHES,  AND  THE  NUTRITIA  TIBIJE. 

II.  FIBULAR  ARTERY;  1.  numerons  muscular  branches 

posterior  fibular  artery  ;  3.  anterior  fibular  artery. 

(near  the  ankle.) 

III.  CALCANEJE. 

IV.  PLANT ARIS  EXTERNA  ;  1 .  Transversus  Anastomoticus , 

2.  Profundse  ;  3.  Digitales,  quartse ;  4.  Interossea 
Profundse;  5.  ANASTOMOTICA,  viz.  with  the  anterior 
tibial  artery. 


139 

PLANTARIS  INTERN  A  ;  1.  branches  to  the  flexor  tendons, 
and  to  the  abductor  and  flexor  pollicis  ;  2.  ProfundsE;, 
viz.  interior,  middle,  exterior  ;  3.  Ramus  Externus. 


DISSECTION 


NER  FES  OF  THE  THIGH  AND  LEG, 


The  arrangement  of  the  nervous  system  of  the  lower  ex- 
tremity, is  very  simple ;  for  there  are  only  a  few  branches 
which  pass  to  the  skin,  and  three  great  nerves  which  supply 
the  muscles. 

The  dissection  of  these  nerves  would  be  very  easy,  were 
they  all  below  the  fascia ;  but  as  the  cutaneous  nerves  are 
superficial  to  it,  it  is  very  difficult  to  show  them  and  the  deep 
nerves  at  the  same  time.  We  should,  therefore,  dissect  the 
cutaneous  nerves  first ;  and  after  having  examined  them,  we 
may  cut  them  through,  or  hold  them  aside,  that  we  may 
make  the  dissection  of  the  deep  branches.* 

If  we  tear  the  peritoneum  from  the  lower  part  of  the  mus- 
cles of  the  abdomen,  and  of  the  loins,  we  shall  see  several 
small  nerves  passing  across  the  iliac  muscles  towards  the 
thigh ;  these  will  be  afterwards  found  to  be  the  cutaneous 
nerves.f  One  of  these  may  be  seen  running  from  the  first 
lumbar,  across  the  psoas  magnus  and  the  quadratus  lumbo- 
rum,  to  the  posterior  part  of  the  spine  of  the  ilium.  From 
this  it  may  be  traced,  for  some  way,  in  a  canal  between  the 

*  It  would,  perhaps,  have  been  better  to  have  described  the 
nerves  of  the  viscera  before  those  of  the  lower  extremity,  as 
it  will  be  necessary  to  remove  them,  before  the  origin  of  se- 
veral of  the  nerves  which  pass  to  the  thigh,  can  be  shown. — 
But  as  this  would  have  broken  in  upon  the  arrangement  of 
the  dissections  of  the  thigh,  the  present  plan  has  been  follow- 
ed; the  nerves  of  the  viscera  will  be  described  with  those  of 
the  thorax  ;  if  the  student  wishes  to  dissect  them  first,  he 
should  refer  to  that  part  of  the  work. 

t  It  is  difficult  to  say  what  names  ought  to  be  given  to  the 
cutaneous  nerves,  because  there  are  very  few  authors  who 


140 

transversalis  and  spine  of  the  ilium  ;  it  then  pierces  the  tran< 
versalis,  and  while  lying  between  it  and  the  internal  oblique, 
divides  into  two  branches — one  of  which  supplies  the  abdom- 
inal muscles  and  integuments ;  the  other  may  be  traced  be- 
tween the  two  muscles,  and  along  Poupart's  ligament,  as  far 
as  the  external  abdominal  ring ;  it  then  perforates  the  apone- 
urosis  of  the  external  oblique,  and  is  lost  upon  the  skin  and 
scrotum  in  the  male,  and  upon  the  labia  in  the  female. 

Another  nerve  may  also  be  traced  from  the  first  lurrrbar, 
across  the  psoas  and  iliacus  internus  ;  it  pierces  the  transyer- 
salis  and  internal  oblique,  and  then  it  gives  off  several  branch- 
es ;  the  principal  one  is  that  which  passes  along  the  crural 
arch  to  the  upper  part  of  the  scrotum.  We  may  now  look 
to  the  second  lumbar  nerve,  and  from  it  we  may  generally 
T  race  a  nerve  which  pierces  the  psoas,  and  crosses  the  ilia- 
cus internus,  to  pass  out  of  the  pelvis,  between  the  two  ante- 
rior spinous  processes  of  the  ilium :  it  will  then  be  found  un- 
der the  fascia  lata ;  here  it  a.ppears  a  little  enlarged,  and  im- 
mediately divides  into  two  branches,  one  of  which  passes  to 
the  skin,  but  the  other  goes  directly  downwards  for  a  short 
distance  before  it  pierces  the  fascia;  it  is  then  distributed  to 
the  skin  on  the  outer  part  of  the  thigh,  nearly  as  far  down  as 
the  knee.  But  the  most  important  branch  of  all  these  cuta- 
neous nerves,  is  that  which  rises  from  the  first  lumbar,  and 
while  it  is  passing  through  the  substance  of  the  psoas,  re- 
ceives a  branch  from  the  second  lumbar.  This  nerve  passes 
along  the  fore  part  of  the  psoas,  and  when  near  the  crural 
arch,  divides  into  two  branches,  the  largest  of  which  follows 
the  course  of  the  spermatic  cord,  and  is  distributed  on  th..* 
scrotum  and  coats  of  the  testicle;  the  other  branch  passes 
under  the  great  vessels,  and  after  giving  twigs  to  the  ingui- 
nal glands,  sends  a  number  of  branches,  through  the  fascia, 
to  the  skin  on  the  fore  part  and  middle  of  the  thigh. 

Besides  the  branches  which  have  just  been  enumerated, 
three  or  four  nerves  will  be  seen  coming  through  the  fascia, 
h>  be  distributed  upon  the  skin  on  the  fore  part  of  the  thigh. 
These  will  be  afterwards  found  to  arise  from  the  anterior 
cruraL 

We  should  now  trace  the  cutaneous  nerves  on  the  hip.  In 
raising  the  skin  from  the  gluteus  maximus,  we  shall  discover 
upon  its  upper  part,  a  set  of  nerves  which  arise  from  the  lum- 
bar ;  on  the  lower  part  of  the  muscle  we  shall  find  another 

use  the  same  terms  ;  but  the  most  common  plan  is  to  give 
them  such  names  as  are  descriptive  of  their  situation — thus 
we  have  the  terms  External  Cutaneous,  Internal  Cutaneou^ 
Middle  Cutanevus,  External  Spermatic,  and  External  Pudu\ 


141 

set,  which  arise  from  the  sacro-ischiatic,  and  the  most  im- 
portant brandies  of  which,  pass  to  the  skin  of  the  perineum 
and  anus.  On  removing-  the  skin  from  the  ham-string  mus- 
<•  les,  several  cutaneous  branches  will  be  seen  passing  down 
on  the  outer  and  inner  edges  of  the  thigh.  Those  which  are 
on  the  inside,  (called  the  Posterior  Internal)  may  be  traced 
from  the  sacro-ischiatic,  as  it  passes  over  the  quadratus  fe- 
inoris ;  and  those  on  the  outside,  (the  Posterior  External ,} 
rise  from  the  great  nerve,  after  it  has  emerged  from  the  glu- 
tens maximus. 

If  we  now  continue  the  dissection  along  the  .superficial 
part  of  the  leg,  we  shall  discover  two  branches,  which  unite 
nearly  opposite  to  the  middle  of  the  gastrocnemius  ;  one  of 
these,  will  be  found  to  arise  from  the  tibial  portion  of  the 
.sacro-ischiatic — the  other  from  tho  peroneal  division ;  they 
may  be  traced  to  the  outer  part  of  the  tendo  Achiliis,  where 
they  unite  with  nerves  from  the  anterior  part  of  the  foot, — 
whence  the  nerve  formed  by  the  union,  has  received  the 
name  of  communicans  tibialis. 

To  discover  the  origin  of  the  cutaneous  nerves  which  sup- 
ply the  fore  part  of  the  leg,  it  will  be  necessary  to  open  the 
.sheath  of  the  femoral  artery,  immediately  before  it  pierces 
the  adductor magrms;  there  we  shall  seethe  nerve  which  is 
called  saphenus  longus.  This  "may  be  traced  under  the  fas- 
cia, to  the  inside  of  the  knee ;  here  it  joins  the  saphena  vein, 
which  it  accompanies  to  the  inner  ankle.  In  its  course,  it 
forms  connections  with  the  cutaneous  nerves  on  the  back  of 
the  leg,  and  with  those  of  the  deeper  nerves, — which  shall 
be  described  presently. 

In  making  the  dissection  of  the  cutaneous  nerves,  we 
should,  at  the  same  time*  attend  to  the  distribution  of  the 
superficial  veins,  which  may  be  seen,  though  uninjected. 
All  the  cutaneous  veins  of  the  leg  are  described  as  forming 
only  two  trunks,  viz.  Saphena  Jttajor,  or  Interna,  and  Saphe- 
na Minor,  or  Externa. 

The  saphena  major  may  be  traced  from  a  plexus  of  veins 
on  the  inside  and  fore  part  of  the  foot ;  from  this  it  passes 
over  the  inner  ankle,  up  to  the  inside  of  the  knee ;  it  then 
passes  upon  the  fascia  lata  to  within  a  hand's  breadth  of  Pou- 
part's  ligament ;  here  it  perforates  the  fascia,  and  unites  with 
the  great  femoral  vein.  We  shall  sometimes  find  it  divided 
into  two  branches  above  the  knee;  but  these  generally  join, 
before  the  vein  perforates  the  fascia. 

The  saphena  minor  rises  from  the  plexus  on  the  back  and 
outer  part  of  the  foot,  from  which  it  may  be  traced,  alontr 
the  middle  of  the  gastrocnemius,  to  the  ham ;  here  it  termi- 
$ates,  by  uniting  with  the  popliteal  vein. 


142 

Some  of  the  superficial  lymphatics  may  be  seen  in  tins 
*tage  of  the  dissection,  but  to  an  inexperienced  eye,  it  will 
be  very  difficult  to  discover  them.  The  manner  of  injecting 
them,  will  be  described  in  a  separate  article  ;  at  present,  I 
shall  only  notice,  that  these  lymphatics  are  immediately  un- 
der the  true  skin ;  that  they  are  more  superficial  than  the 
veins  and  nerves;  that  they  run  in  straight  lines,  and  are 
only  partially  seen,  or  seem  to  be  abruptly  broken  off,  by  tin? 
intervening  pellicles  of  fat.  They  appear  very  large  and 
varicose  when  distended,  especially  in  the  course  of  the  sa- 
phena  vein;  and  they  are  more  numerous  upon  the  middle 
part  of  the  thigh,  than  upon  the  outer  part.  In  colour  and 
appearance,  when  in  their  natural  state,  and  collapsed,  they 
resemble  loose  muscular  fibies,  being  flat  reddish  lines;  be- 
ing pellucid  only  when  distended  with  air.  When  they  are 
blown  up,  or  injected  with  mercury,  they  take  a  very  pecu- 
liar appearance,  for  they  swell  only  betwixt  their  valves. 
The  lymphatics  of  the  thigh,  pass  into  the  glands  at  the  groin, 
but  we  must  particularly  notice  that  there  are  three  sets  of 
glands  here — the  first  receive  the  lymphatics  from  the  super- 
ficial part  of  the  thigh,  the  second  receive  the  lymphatics  of 
the  skin  of  the  penis  and  scrotum,  and  perineum,  while  a 
deeper  set  are  formed  by  the  lymphatics  which  accompany 
the  great  arteries  of  the  legs 

When  the  glands  are  injected,  secondary  lymphatics  may 
be  traced  from  them  into  another  set  of  glands.  The  lymph 
is  then  carried  from  these,  by  a  third  set  of  vessels,  to  glands 
which  have  a  direct  communication  with  the  thoracic  duct. — 
The  superficial  lymphatics  on  the  back  of  the  leg,  may  be 
traced  into  a  gland  in  the  ham. 

Previous  to  the  dissection  of  the  deep  serves  of  the  thigh, 
a  section  of  the  pelvis  should  be  made,  according  to  the  second 
method  described  at  page  72.  • 

As  it  is  supposed  that  all  the  nerves  of  the  viscera,  and  the 
cutaneous  nerves  of  the  thigh,  have  been  already  traced,  we 
have  now  to  attend  only  to  the  origins  of  the  Anterior  Cru- 
iv//,  Obturator,  and  Ischiatic  Nerves. 

The  fibres  of  the  psoas  muscle  must  be  freely  cut,  so  that 
we  may  e'xpose  the  plexus  of  nerves  which  gives  origin  to 
the  Anterior  Crural.  This  plexus  is  generally  formed  by 
the  second,  third,  and  fourth  lumbar,  and  the  first  sacral. 

The  anterior  crural  may  be  traced  in  the  angle  between 
the  psoas  and  iliacus,  as  far  as  the  edge  of  Poupart's  liga- 
ment; but  before  we  trace  it  farther,  we  should  attend  to 
the  -Obturator,  which  is  seen  passing  across  the  pelvis,  to- 
wards the  thyroid  hole.  If  we  trace  this  nerve  back  towards 
the  loins,  we  shall  find  it  in  close  connection  with  the  ante- 


113 

rior  crural  nerve;  for  it  also  arises  from  a  plexus,  Which  is 

formed  by  the  third  and  fourth  lumbar  nerves,  and  sometimes 
by  a  twig  from  the  second. 

By  a  very  little  dissection,  we  may  now  expose  the  great 
plexus  of  the  Sacra-sciatic  Nerve.  When  this  is  traced  back- 
ward, it  will  be  found  to  be  formed  by  the  fourth  and  fifth 
lumbar,  arid  by  the  first,  second,  and  third  sacral  nerves.* 

The  three  great  nerves,  viz.  Anterior  Crural,  Obturator* 
and  Sacro-uchiatic,  may  now  be  traced  to  their  final  distribu- 
tion. 

The  Anterior  Crural,  having  passed  under  Poupart's  liga- 
ment, immediately  splits  into  a  great  number  of  branches, 
many  of  which  may  be  traced  into  the  muscles  at  the  upper 
part  of  the  thigh ;  while  others,  which  have  been  already  de- 
scribed, go  to  the  skin. 

Of  the  muscular  branches  there  are  only  two  which  it 
is  of  much  importance  to  trace,  arid  both  of  these  run  parallel 
to  the  femoral  artery.  The  most  external  one  does  not  run 
close  upon  the  artery,  but  inclines  towards  the  vastus  inter- 
mis,  upon  which  it  is  distributed;  while  the  internal,  (which 
is  called  the  saphenus  longus,)  passes  almost  in  the  proper 
sheath,  until  thn  artery  perforates  the  triceps.  The  nerve 
may  then  be  traced  to  the  inside  of  the  knee,  to  become  the 
cutaneous  nerve,  which  has  been  already  seen  going  to  the 
inner  ankle,  along  with  the  saphena  vein. 

To  show  the  branches  of  the  Obturator,  we  must  dissect 
between  the  heads  of  the  triceps :  here  we  shall  find  many 
tvvigs,  but  of  these,  the  only  important  ones  are  one  or  two 
which  run  along  the  inside  of  the  thigh,  to  unite  with  the  sa- 
phenus lougus.- 

While  the  Sacro  Isrhiatic  Nerve  is  in  the  form  of  a  plexus 
in  the  pelvis,  it  gives  off  several  branches,  the  principal  of 
which  is  the  P-mlic  :  indeed,  this  may  be  considered  a  separate 
nerve,  as  it  arises  from  the  third,  fourth,  and  fifth  sacral 
nerves.  It  may  be  traced  by  the  side  of  the  tuber  ischii, 
along  with  the  arteries,  to  the  muscles  of  the  perineum,  and 
to  the  penis.  In  the  female,  it  is  distributed  on  the  vagina 
and  clitoris. 

The  trunk  of  the  ischiatic,  after  giving  off  the  pudic, 
passes  to  the  outer  part  of  the  pelvis ;  it  generally  lies  be- 
tween the  pyriformis  and  gemini  muscles,  but  it  is  not  un- 

*  These  lumbar  and  sacral  nerves  may  be  more  easily 
counted  by  looking  into  the  section  of  the  spinal  canal. 
When  the  nervee  of  both  sides  are  preserved,  and  pulled  out 
from  the  spinal  canal,  there  is  the  appearance  produced, 
which  has  been  called  Cauda  Equina. 


144 

usual  to  find  the  pyriformis  perforated  by  the  nerve ;  some- 
times, indeed,  the  nerve  is  divided,  by  the  tendon,  into  two 
branches,  which,  however,  soon  again  unite.  While  the 
nerve  lies  here,  it  gives  several  small  twigs  to  the  muscles 
and  to  the  skin.  The  two  great  gluteal  muscles  should  now 
be  raised,  by  which  we  shall  expose  the  nerve  where  it  passes 
betwixt  the  tuberosity  of  the  ischium  and  great  trochanter ; 
the  two  ham-string  muscles  must  then  be  dissected  to  show 
the  course  of  the  nerve  between  them. 

About  the  middle  of  the  thigh,  the  sciatic  nerve  will  be 
found  to  divide  into  two  great  branches,  the  Tibial  and  Fi- 
bular.  The  trunk,  however,  will  very  often  appear  to  go 
quite  into  the  ham,  without  dividing ;  but  still  we  shall  find 
that  it  may  be  very  easily  split,  for  some  way  up,  into  two 
portions. 

The  Tibial  should  be  traced  first.  The  first  branch  of 
importance,  is  that  which  has  been  already  seen  in  the  dis- 
section of  the  cutaneous  nerves  (JVcrvus  Communicans  Ti- 
bialis.)  After  having  given  off  this  branch,  the  trunk  passes 
through  the  popliteal  space,  giving  off  small  branches  to  the 
back  of  the  joint,  and  to  the  muscles. 

The  internal  heads  of  the  gastrocnemius  and  sole  us  should 
now  be  divided,  so  that  we  may  exhibit  the  nerve  in  its  course 
under  the  fascia  which  covers  the  deep  muscles.  As  it  pas- 
ses to  the  ankle,  it  gives  oifseveral  branches, — the  principal 
one  of  which  passes  between  the  bones  to  supply  the  muscles 
on  the  fore  and  upper  part  of  the  interosseous  ligament.  At 
the  internal  ankle,  the  trunk  will  be  found  lying  close  upon 
the  posterior  tibial  artery  ;  and  whilg  here,  it  gives  off  a  cui 
taneous  branch  to  the  inside  of  the  foot. 

The  Internal  Plantar,  which  is  the  largest,  after  giving  off 
several  branches  to  the  muscles,  is  finally  distributed  to  the 
great  toe,  second,  third,  and  one  side  of  the  fourth  toe. 

The  External  supplies  its  corresponding  muscles, — forms 
a  connection  with  the  internal  plantar,and  then  supplies  the 
little  toe,  and  one  side  of  the  fourth  toe. 

The  Fibular  Division  of  the  great  sciatic  may  now  be 
traced.  Before  it  passes  round  the  head  of  the  fibula,  it  gives 
off  the  cutaneous  branch  which  has  been  described  as  con- 
nected with  the  communicans  tibialis.  After  tracing  the 
trunk  over  the  fibula,  it  will  be  found  lying  very  deep  be- 
tweeen  the  muscles,  where  it  immediately  divides  into  two 
nerves.  The  most  superficial  should  be  traced  first :  it  gen- 
erally sends  one  branch  into  the  muscles,  and  then,  passing 
under  the  head  of  the  peroneus  longus,  may  be  traced  under 
the  aponeurois,  to  the  skin  on  the  fore  part  of  the  foot,  where 
it  unites,  on  the  outer  part,  with  the  communicans  tibialis, 


145 

and,  on  the  inner  part,  \vith  the  internal  plantar  branches 
Those  branches  on  the  fore  part  of  the  ibot,  are  sometimes 
called  Metatarml  Nerves.  We  may  now  return  to  the  dis- 
section of  the  deep  nerve,  which  is  sometimes  called  the  An- 
terior Tibial  -Nerve,  as  it  accompanies  the  artery.  It  runt?, 
almost  close  upon  the  interosseous  ligament,  between  the 
deep  muscles,  as  far  as  the  ankle, — there  it  divides  into  two 
branches,  which  are  called  Ramus  -Dorsalis  PecHs  Profwrxhis, 
and  Superficial.  The  profundus  may  be  traced,  under  the 
extensor  brevis,  to  the  outside  of  the  tarsus.  The  superfi- 
cialis,  though  so  called,  runs  deep  under  the  tendons,  u;xi 
at  last  comes  out  betwixt  the  great  and  second  tee. 


SURGICAL  DISSECTION 

OF 

THE  LOWER  EXTREMITY. 


I  SHALL  nowr  endeavor  so  to  describe  the  manner  of  ma- 
king the  dissection,  as  to  enable  the  student  to  understand 
the  principal  points  of  the  anatomy  by  which  .he  is  to  be  gui- 
ded in  the  treatment  of  many  of  the  most  important  cases  in 
surgery. 

The  arteries  should  not  be  injected — nor  should  the  abdo- 
men be  opened :  and  if  we  wish  to  examine  the  parts  connect- 
ed with  the  subject  of  hernia,  we  should  not  make  the  deep 
dissection,  until  we  have  seen  the  relative  situations  of  the 
#reat  arteries  ;  because  the  most  important  questions  which 
may  be  understood  from  the  views  of  the  natural  state  of  thr 
parts,  relate  to  the  different  operations  which  it  may  be  ne- 
cessary to  perform  for  the  various  kinds  of  aneurism.  But 
here  1  must  beg  the  student  to  understand,  that  he  will  be 
sadly  disappointed  if  he  expects  to  see  the  parts  as  distinctly 
in  an  operation  as  he  will  now  see  them  on  dissection.  He 
should,  therefore,  at  the  time  he  is  investigating  the  anato- 
my, not  only  read  the  histories  of  all  the  cases  and  operations? 
which  have  been  published,  but  also  those  works  in  whicf; 
the  principles  that  are  to  guide  us  in  determining  on  the 
mode  of  operating,  are  discussed.  If  he  does  this,  he  will 
then  be  able  to  assign  the  great  improvements  that  of  lalfr 
$r-urs  have  taken  place,  to  their  proper  source, 


146 

With  the  hope  that  the  student  will  attend  to  the  patholo- 
gy of  aneurism,  I  ghall  now  confine  myself  to  such  points  as 
maybe  understood  by  the  examination  of  the  parts  in  the 
(lead  body. 

The  aorta  has  been  tied  for  an  aneurism  of  the  inguinal  ar- 
tery ;  but  the  detail  of  the  operation,  and  of  the  cases  which 
were  adduced  in  support  of  the  principle  upon  which  it  was 
done,  are  sufficient  to  deter  us  from  ever  repeating  the  exper- 
iment. The  common  iliac  has  been  twice  tied  ;  and  though 
the  operations  were  unsuccessful,  still  the  circumstances,  in 
the  one  which  I  witnessed,  were  so  far  favorable,  that  we 
may  expect,  in  certain  cases,  to  tie  this  vessel  with  success  : 
but  I  shall  not  give  a  separate  description  of  the  manner  of 
dissecting  for  it,  because  it  may  be  easily  found  by  making 
a  little  variation  in  the  operation  for  tying  the  internal  iliac. 

But  the  most  important  operation,  because  .it  is  the  more 
common,  is  that  upon  the  external  iliac.  I  ghall,  therefore, 
particularly  describe  the  manner  in  which  this  artery  may 
be  most  easily  found,  and  safely  tied,  for  an  aneurism  at  the 
groin.  I  shall  suppose  that  the  dissection  is  made  on  the  liv- 
ing body  ;  and,  in  the  description  of  it,  I  shall  nearly  follow 
that  given  by  Mr.  C.  Bell,  in  the  Illustrations  of  the  Great 
Operations  of  Surgery. 

"  The  object  of  this  operation  is,  to  tie  the  external  iliac 
artery  so  high,  that  the  wound  shall  not  interfere  with  the 
tumor  of  the  aneurism,  rioropen  the  coagulated  blood  to  the 
influence  of  the  air,  nor  excite  inflammation  in  the  sac,  by 
its  contiguity.  The  wound  must  not  be  a  penetrating 
wound, — that  is,  there  must  be  no  breach  of  the  investing 
membrane  of  the  abdomen  ;  or  the  patient's  clanger  will  be 
increased  a  hundred  fold. 

"  Incision.  Having  ascertained  the  middle  point  betwixt 
the  superior  spinous  process  of  the  os  ilii  and  the  KymphisiB 
pubis,  you  feel  there  the  pulsation  of  the  artery.  Next  feel 
the  spermatic  cord,  and  trace  it  backwards  into  the  abdcmr- 
iial  ring  ;  and  mark  where  it  disappears.  You  have  now 
got  two  points  to  direct  your  incision  ;  make  another,  by 
drawing  a  line  from  the  superior  spinous  process  of  the  os 
ilii  to  the  umbilicus  ;  mark  a  point  npon  this  line,  two  fingers' 
breadth  from  the  process.  Begin  the  incision  opposite  th£> 
outer  margin  of  the  "abdominal  ring  ;  carry  it  over  the  point 
•where  you  felt  the  artery  beating,  in  a  direction  outward  and 
upward,  and  let  it  terminate  at  the  point  you  have  marked  at 
two  fingers'  breadth  from  th«  spinous  process  of  the  os  ilii 
measured  in  a  direction  towards  the  umbilicus. 

"  Second  Incision*  Having  exposed  the  aponeurosie  or 
tendon  of  the  external  oblique  muscle,  and  observed  the  di 


147 

rection  of  its  fibres  pass  the  directory  into  the  ring,  and  into 
the  spermatic  passage  ;  taking  care  that  the  instrument  is 
directly  close  under  the  tendon,  and,  consequently,  external 
to  the  cord:  slit  up  the  tendon  in  the  direction  of  its  fibres. 

"  Tke  Cord.  The  spermatic  cord  is  now  exposed.  With 
the  blunt  hook,  and  the  handle  of  the  knife,  the  cord  is  to  be 
raised  and  pressed  upward  and  inward.  In  doing  this,  you 
will  necessarily  raise  the  lower  edge  of  the  obliquus  internns 
muscle.  If  the  patient  be  fat,  or  the  aneurism  prominent  and 
high,  the  wound,  in  this  state,  will  be  too  confined  ;  and  it 
will  be  necessary  first  to  pass  the  directory,  and  then  the 
point  of  the  finger  under  the  edge  of  the  muscles,  and  to  di- 
vide them  in  a  direction  upwards.  The  condensed  cellular 
membrane,  or  fascia,  which  is  on  the  lower  surface  of  the 
transversalis,  will  generally  yield  to  the  finger. 

"  There  will  be  found  a  soft  mass  just  within  the  Poupart 
ligament ;  it  may  be  mistaken  for  a  vessel  ;  the  more  espe- . 
cialiy,  as  the  pulsation  may  be  felt  on  pressing  it.  It  is  a 
lymphatic  gland.  This  gland  is  to  be  left  in  its  place.  Above 
this,  there  is  a  soft,  fatty  substance,  which  is  to  be  put  aside 
with  the  finger  and  the  handle  of  the  knife  ;  and  now>  upon 
putting  in  the  finger,  the  artery  will  be  distinctly  felt. 

"  The  space  where  you  feel  the  artery,  is  thus  defined  : 
1.  Balow,  towards  the  thigh,  there  is  the  Pourpart  ligament, 
and  the  internal  inguinal  gland.  2.  On  the  inside,  towards 
the  pubes,  you  have  the  epigastric  artery.  3.  Above,  and 
towards  the  ilium,  there  is  the  edge  of  the  oblique  and  trans- 
versalis  muscle.  4.  And  above,  and  towards  the  rectus,  you 
have  the  spermatic  cord. 

"  You  should  now  push  up  the  spermatic  cord  and  cellu- 
lar membrane,*  and  you  place  an  assistant's  finger  there,  to 
guard  the  peritoneum  ;  you  have  the  epigastric  artery  on 
the  inside,  still  involved  in  its  cellular  membrane  :  you  may 
now  expose  the  artery. 

"  Feeling  the  artery  full,  and  pulsating  und^r  your  finger, 
you  think  it  bare,  when  a  little  consideration  should  remind 

*  To  me,  it  appears  that  there  are  good  reasons  for  push- 
ing up  the  spermatic  cord.  First,  you  get  much  easier  at 
I  he  artery.  Secondly,  you  have  the  spermatic  cord  betwixr, 
you  and  the  peritoneum.  Thirdly,  if  you  incline,  you  may, 
in  this  direction,  push  the  peritoneum  very  high,  and  expose 
the  external  iliac  artery  at  its  highest  point ;  whereas,  if 
you  go  above  the  spermatic  cord,  and  keep  it  in  its  place,  you 
must  be  entangled  in  the  reflection  of  the  vast  deferens,  and 
you  will  make  the  peritoneum  thin  as  a  cobweb,  by  separa- 
ting the  cellular  tissue  of  the  wrdfrom  it. 


118 

you  that  it  is" not.*  It  is  still  covered  with  its  sheath,  and  ill 
aments  of  the  fascia  strengthen  that  sheath  :  and  here  1 
must  again  observe,  that  the  safest  way  is,  to  scratch  the 
sheath,  directly  over  the  centre  of  the  artery;  to  cut  at  the 
•side  of  the  artery  is  dangerous.  The  vein  lies  close  by  the 
inside  of  the  artery,  and,  in  some  measure,  below  it.  The 
vein  is  on  the  inside,  the  anterior  crural  nerve  on  the  outside. f 
Therefore,  I  advise  you  to  scratch  until  you  can  pass  your 
probe  or  blunt  hook  through  the  sheath  and  ligament  ous 
fibres  which  directly  cover  the  artery. 

"  When  you  have  exposed  the  proper  coat  of  the  artery, 
make  the  assistant  raise  the  thigh  as  much  as  the  circum- 
stances of  the  tumor  will  admit  ;•  then  you  will  be  able  to 
a- rasp  the  artery  betwixt  the  thumb  and  the  fore  finger  ;  you 
will  find  it  so  loose,  that  you  will  experience  no  difficulty  in 
i»ns?ing  the  needle  under  it.  It  is  struggling  to  thrust  the 
•blunt  needle  through  the  sheath  and  fibres  of  the  fascia,  and 
neo'lecting  to  raise  the  limb,  that  makes  this  part  of  the  ope- 
u  tedious. 

One  firm  ligature  of  four  threads,  waxed  and  oiled,  will 
ho  sufficient ;  it  is  not  necessary  to  tie  the  artery  twice,  nor, 
consequently,  to  cut  it  across.  "J 

The  operation  of  tying  the  external  iliac  artery,  has  been 
very  successful,  when  performed  for  spontaneous  aneurism 
of  the  inguinal  artery,  but  not  for  the  aneurism  that  rises  in- 
consequence of  a  wound  of  this  vessel.  It  is,  therefore,  of 
the  greatest  importance  to  attend  to  the  distinction  of  these 

*  Mr.  Albemarle  says,  "  The  pulsation  of  the  artery  made 
it  clearly  distinguishable  from  the  conspicuous  parts,  but  1 
could  not  get  my  finger  round  it  with  the  facility  which  I  ex- 
pected" "  After  ineffectual  trials  to  pass  my  finger  beneath 
the  artery,  I  was  obliged  to  make  a  slight  incision  on  either 
side  of  it,  in  the  same  manner  as  is  necessary  when  it  is  ta- 
ken up  in  the  thigh,  where  the  fascia,  which  binds  it  down  in 
its'  situation  is  strong."  This  double  incision  is  not  necessa- 
ry in  either  of  these  cases  ;  and,  I  apprehend,  very  danger- 
ous in  the  present  instance. 

f  The  external  iliac  vein  is  close  to  the  inside  of  the  arte- 
ry. The  anterior  crural  nerve  is  quite  removed  from  the  ar- 
tery. 

J  Mr.  John  Bell  and  Mr.  Abernethy,  and  Mr.  Maunoir  of 
Geneva,  have  been  advocates  for  tying  the  artery  twice,  and 
cutting  it  betwixt  the  ligatures.  It  is  a  practice  which  may 
have  advantages ;  but  the  idea  that  they  thereby  made  thr 
artery  as  secure  as  when  tied  in  amputation,  was  undoubted 
\y  a  great  mistake. 


149 

v.;is'-s.  This  difference  was  first  particularly  explained  b) 
Mr.  Charles  Boll  ;  for  he  showed,  that,  in  th'e  case  of  spon- 
taneous aneurism,  the  tying  of  the  artery  at  a  certain  dis- 
tance above  the  aneurism,  would  generally  be  successful ; 
but  that  the  artery  must  be  tied  above  and  below  an  aneurism- 
which  has  arisen  in  consequence  of  a  wound.  As  it  is  not 
possible  to  guess  where  it  may  be  necessary  to  perform  such 
an  operation,  we  ought  to  make  ourselves  acquainted  with 
all  the  connections  of  the  artery  through  its  whole  course, 
that  we  may  feel  confident  when  called  .upon  to  take  it  up, 
at  any  point,  in  the  living  body. 

The  operation  of  tying  the  internal  iliac  artery,  has  been 
performed  for  aneurism  of  the  gluteal  artery,  with  success. 
The  operation  was  thus  described  to  me  by  Dr.  Stevens  : — 

"  I  made  an  incision,  about  five  inches  in  length,  on  the 
lower  and  lateral  part  of  the  left  side  of  the  abdomen,  nearly 
half  an  inch  to  the  outside  of  the  epigastric  artery,  and  par- 
allel to  that  vessel.  After  dividing  the  skin  and  the  three 
abdominal  muscles,  successively,  I  separated  the  peritoneum 
from  its  connection  with  the  iliacus  interims  and  psoas,  and 
then  pushed  it  up  towards  the  division  of  the  common  iliac. 
Here  I  was  able  to  insinuate  my  finger  behind  the  internal 
iliac,  and  then  to  compress  it.  between  my  finger  and  thumb ; 
I  then  passed  a  ligature  befow  the  artery,  with  a  blunt  nee- 
dle, and  tied  it  with  a  single  ligature,  about  half  an  inch 
from  its  origin."  The  pulsation  in  the  aneurism  immediate- 
ly stopped,  and  the  patient,  got  well. 

Though  it  is  difficult  to  suppose  that  such  a  case  will  oc- 
cur, as  would  make  it  necessary  to  tie  the  gluteal  or  ischiatic 
arteries,  where  the  parts  surrounding  them  are,  at  the  same 
time,  in  a  natural  state, — still  I  shall  describe  the  manner  in 
which  these  arteries  may  be  found,  where  the  pressure  of 
the  blood  has  not  destroyed  the  tissue  of  the  muscles. 

For  the  Gluteal.  The  body  should  be  laid  flat  on  the  bel- 
ly, and  the  foot  should  be  turned  inwards.  The  incision 
should  begin  at  two  fingers'  breadth  below  the  posterior 
epiaous  process  of  the  ilium,  and  be  continued  towards  the 
upper  part  of  the  trochanter  ;-.iajor.  The  fibres  of  the  glute- 
us  raaximus  and  medius,  are  then  to  ba  divided,  to  the  low- 
er edge  of  the  ilium,  and  there,  at  the  notch,  and  immediate* 
ly  above  the  pyriforinis  muscle,  the  artery  will  be  found.  In 
making  these  incisions,  we  must  necessarily  cut  through  se- 
veral very  large  arteries. 

The  incision  for  the  Itchiatic  artery  is  to  be  begun  at  the 
side  of  the  sacrum,  at  about  three  inches  from  the  posterior 
•spinous  process  of  the  ilium,  and  is  to  be  carried  in  the  length 
*ft&e  fibres  of  the  gkite.us  maximum  to  the  eutskle  tftJie 


150 

tuberosity  of  the  ischium  ;  by  pushing  in  the  finger,  we  shatf 
feel  the  external  sacro  sciatic  ligament,  along  which,  and 
immediately  under  the  margin  of  the  pyriformis,  the  artery 
passes.  The  great  nerve  is  about  an  inch  to  the  iliac  side 
of  the  artery. 

We  may  now  proceed  to  the  consideration  of  the  most, 
common  operation  which  is  performed  on  the  arteries  of  the 
lower  extremity, — the  ligature  of  the  superficial  femoral  ar- 
f  ery,  for  popliteal  aneurism. 

As  this  operation,  in  nine  out  of  ten  cases,  is  done  upon 
parts  which  are  in  their  natural  state,  we  can  now  form  very 
nearly  an  accurate  idea  of  the  steps  of  an  operation, — which 
is  little  more  than  a  simple  dissection,  made  upon  the  living 
body. 

The  limb  should  be  laid  rather  on  the  side  ;  a  point  is  then 
to  be  marked  on  the  groin,  equidistant  from  the  symphysis 
of  the  pubes,  and  the  superior  spinous  process  of  the  ilium. 
Here  the  artery  will  be  felt.  A  cord  may  be  fixed  at  that 
point,  and  stretched  to  the  patella  ;  an  assistant  should  then 
stretch  another  cord  bet  ween  the  superior  spinous  process  of 
the  ilium  and  the  inner  condyle  of  the  femur.  The  centre 
of  the  incision  should  be  about  an  inch  above  the  point  where 
these  lines  cross  ;  it  should  be  made  about  three  inches  long: 
not  in  the  line  of  the  fibres  of  the  sartorius,  but  rather  across 
them.  The  skin  is  to  be  divided  in  the  first  incision  ;  and  in 
the  second,  the  thin  superficial  fascia,  which  should  be  cut 
to  the  full  extent  of  the  incision  through  the  skin.  As  the 
cut  is  made  in  a  line  across  the  sartorius,  there  will  be  little 
difficulty  in  recognizing  this  muscle.  (And  here  I  may  re* 
mark,  that  none  except  those  that  have  witnessed  the  exhibi- 
tion, can  imagine  the  difficulties  which  have  ensued,  in  con- 
sequence of  the  edge  of  the  triceps  having  been  mistaken  for 
the  sartorius.)  The  lower  edge  of  the  sartorius  is  now  to 
be  raised, — this  will  expose  the  fascia  which  passes  from  the 
triceps  to  the  vast  us  internus  ;  a  little  perforation  is  then  to 
be  made  into  the  fascia,  and  a  directory  is  to  be  passed  under 
it,  so  that  it  may  be  slit  up.  The  sheath  which  surrounds 
the  artery,  vein  and  nerve,  will  now  be  seen,  and  when  this 
is  opened,  it  will  be  easy  to  pass  a  blunt  needle  under  the  ves- 
sols. 

The  saphena  nerve  is  so  far  removed  from  the  artery,  that 
it  can  easily  be  avoided ;  if  it  be  tied,  the  patient  will,  as 
long  as  he  Jives,  be  a  reproach  to  the  surgeon,  for  he  will 
complain  of  a  pain,  so  distinctly  in  the  course  of  the  nerve, 
that  there  never  will  be  a  doubt  as  to  whom  he  owes  it.  The 
internal  saphena  vein  is  quite  out  of  the  line  of  the  incision 


151 

lias  been  recommended  ;  but  as  it  is  irregular  in  if  ^ 
Bourse,  its  situation  should  be  marked,  previous  to  com- 
mencing the  operation,  by  compressing  it  high  up.  (Thr 
anatomy  of  popliteal  aneurism  will  be  described  when  we 
come  to  the  dissection  of  the  ham.) 

We  may  now  open  the  abdomen,  and  examine  the  rela- 
tive position  of  the  parts  connected  with  the  arteries  which 
we  have  tied.  The  internal  iliac  vein  and  the  ureter  will 
be  looked  to  with  interest,  in  considering  the  operation  of 
tying  the  internal  illiac  artery. 

*  After  having  fully  investigated  the  subject  of  the  operation 
for  aneurism,  in  all  its  bearings,  we  should  make  a  superfi- 
cial dissection  of  the  fascia  of  the  thigh, — preserving  the 
veins,  nerves,  and  glands.  The  lymphatics,  of  course,  cannot 
be  seen. 

The  first  thing  we  should  attend  to,  is  the  anatomy  of  the 
glands.  As  the  lymphatics  pass  from  several  sources  into 
the  glands,  we  may  now  understand  that  there  may  be  many 
different  causes  for  bubo.  If  there  be  a  deep  swelling  in  the 
groin,  it  may  be  in  consequence  of  some  irritation  on  the  in- 
ternal parts  of  the  limb, — as  after  compound  fracture,  disea- 
sed joint  or  bone.  If  the  swelling  be  more  superficial,  it 
may  arise  from  irritation  of  the  superficial  lymphatics  in  some 
part  of  their  course, — as  that  produced  by  a.  blister  on  the 
knee,  or  by  a  sore  on  the  toe.  If  the  tumour  be  high  up  in  the 
groin,  it  will  probably  be  from  irritation  on  some  part  of  the 
penis  or  scrotum.  But  there  is  another  cause  of  bubo,  which 
on  account  of  the  difficulty  of  tracing  the  lymphatics,  is  not 
generally  known,  viz.  irritation  about  the  anus, — as  piles, 

&,€. 

Though  buboes  have  been  mistaken  for  hernia,  and  what 
is  more  serious,  hernia  has  been  mistaken  for  bubo,  I  hope  it. 
is  not  now  necessary  to  say  any  thing  on  the  manner  of  dis- 
tinguishing the  two  diseases. 

When  we  recollect  the  origin  of  the  small  nerves  which 
we  now  see  on  the  thigh  and  hip,  we  cannot  wonder,  that 
painful  sensations  in  the  thighs,  should  be  occasionally  re- 
lieved by  such  purges  as  will  completely  empty  the  colon  and 
rectum. 

By  now  making  a  very  little  dissection  over  the  outer 
edge  ofthe  psoas  muscle,  we  shall  expose  the  course  which 
the  lumbar  abscess  generally  takes  ;  and  when  we  recollect  ' 
the  relations  ofthe  fascia  iliaca,  we  shall  understand  why  this 
abscess  seldom  or  never  points  at  the  same  part  that  femoral 
hernia  protrudes. 

The  lumbar  abscess  appears  in  the  groin,  commonly  upon 
the  outside  of  the  femoral  artery,  under  the  stronger  part  of 


152 

the  fascia,  and  near  the  os  ilium.  When  the  tumor  form* 
slowly  and  regularly,  the  fascia  can  be  plainly  felt ;  but  when 
it  is  far  advanced,  the  fascia  generally  gives  way.  This  ab- 
scess, however,  does  not  always  point  thus  regularly,  but  is 
.sometimes  more  extensively  diffused  in  the  groin, — even  sur- 
rounding and  including  the  femoral  vessels ;  or  it  runs  so 
deeply  among  the  muscles,  that  the  lancet  or  trochar  cannot 
reach  it  with  safety.  In  the  dead  body,  upon  laying*  open 
the  abscess  in  the  thigh,  and  freeing  it  of  matter,  a  new  dis- 
charge will  be  seen  to  come  from  within  the  belly.  Upon 
following  this  sinus,  it  will  be  found  to  run  up,  behind  the 
psoas  muscle,  upon  the  vertebrae  of  the  loins,  which  are  often 
carious.  In  some  instances,  the  abscess  continues  its  course 
by  the  sacrum  and  side  of  the  rectum,  and  points  by  the  side 
of  the  anus;  and  it  has  even  made  its  way  into  the  thorax; 
With  this  view  of  the  fascia  before  us,  we  at  once  compre- 
hend the  importance  of  making  free  incisions,  when  matter  is 
collected  below  it.  WTe  may  now  make  the  dissection  of  the 
deep  parts  of  the  thigh. 

When  the  fascia  is  cut  through  below  the  groin,  we  shall 
see  the  vessels  connected  together  by  a  separate  fascia, 
which  is  called  the  sheath  ;  the  great  vein  is  here  on  the  in- 
side of  the  artery,  but  it  turns  more  and  more  under  the  arte- 
ry as  it  descends  to  pass  through  the  triceps  muscle.  The 
vein  is  very  strong  in  its  coats  ;  and  perhaps,  in  an  opera- 
tion, it  might  be  mistaken  for  the  artery,  if  the  surgeon  were 
to  judge  by  the  feeling  betwixt  his  fingers, — which  in  many 
cases  is  a  good  criterion. 

The  femoral  artery,  as  it  descends  from  the  groin,  gets  be- 
twixt the  tendinous  insertions  of  the  triceps  and  the  origin  of 
the  vastus  interims  muscles.  Betwixt  these  two  muscles, 
there  is  such  an  interlacing  of  tendinous  filaments,  that  they 
form  the  bottom  of  a  deep  groove,  in  which  the  artery  runs  ; 
and  here  it  is  covered  by  that  fascia  which  has  in  part  been 
out.  to  expose  the  artery,  in  performing  the  operation  for 
aneurism. 

We  may  now  trace  the  artery  through  the  sheath  formed 
by  the  tendon  of  the  adductor  magnus  ;  and  we  should  par- 
ticularly notice  a  branch  which  is  given  off  here, — for  though 
it  is  small,  it  is  of  considerable  importance  in  the  operation 
of  amputation  of  a  diseased  knee;  for  as  this  is  the  part,  at 
wjiich  the  great  artery  will  be  generally  cut,  there  is  some 
chance  of  this  branch  being  overlooked  in  the  securing  of 
t  he  vessels  :  and  when  this  has  happened,  a  dangerous  hse- 
morrhage  has  been  the  consequence.  The  easiest  \vay  oi* 
-luuuiging1  this  small  vessel,  will  be,  to  pull  the  main  artery 


153 

ouiot*  its  sheath,  so 'that  we  may  apply  a  ligature  above  th<j 
point  where  the  branch  is  given  off. 

Having  completed  the  dissection  of  the  deep  parts  of  the 
t  high,  we  should  retire  a  step  from  the  body,  and  look  to  the 
general  figure  of  the  limb,  and  notice  carefully  the  course  of 
the  artery  down  the  thigh ;  the  probability  of  its  being 
wounded  by  stabs  in  such  and  such  places  and  directions ; — 
the  situation  of  the  trunk  of  the  profunda,  as  distinguished 
from  the  great  artery,  and  the  probability  of  wounds  of  tho 
descending  branches  of  the  profunda  being  mistaken  for 
wounds  of  the  femoral  artery  itself. 

As  in  this  dissection  we  should  also  preserve  the  branches 
of  the  obturator  and  anterior  crural  nerve,  we  shall  be  able 
to  comprehend,  from  the  view  of  them,  why  patients  fre- 
quently suffer  pain  in  the  inside  of  the  knee,  in  the  primary 
stages  of  disease  of  the  hip  joint.  The  course  of  the  dee]) 
nerves  may  also  explain  to  us  the  cause  of  some  very  odd 
symptoms,  which  occasionally  occur; — such  as  violent  burn- 
ing pain  in  the  sole  of  the  foot.  One  of  the  most  interesting 
ca^es  of  this  kind,  is  related  in  Mr.  C.  Bell's  System  of  Ope- 
rative Surgery.  I  have  seen  a  very  striking  example  of  it, 
from  a  curious  cause. — A  Russian  surgeon  thought  he  might 
destroy  a  ball  which  was  lodged  in  the  condyle  of  the  femur, 
by  pouring  quicksilver  into  the  wound.  Upon  amputation  of 
the  leg,  a  tumour  was  found  in  the  peroneal  nerve,  with  a 
quantity  of  quicksilver  in  it.  The  patient,  who  was  a  Rus- 
sian General,  got  well,  but  suffered  long  after,  from  the  same 
nervous  feelings  which  he  had  had,  previous  to  the  ope- 
ration: tlie  nerve  was,  in  all  probability,  irritated  higher 
up. 

Before  dissecting  off  the  skin  from  the  leg,  we  should  exa- 
mine the  parts  nT  tne  ham;  and  then  we  shall  be  able  to 
form  some  idea  of  the  benefit  which  Mr.  Hunter  conferred 
upon  surgery,,  in  performing  the  operation  for  popliteal  aneu- 
rism, by  tying  the  artery  on  the  fore  part  of  the  thigh,  in- 
stead of  persevering  in  the  old  method  of  tying  it  in  the  ham  : 
a.  plan  which  was  followed  by  some  of  the  first  surgeons  in 
France,  up  to  the  year  1814. 

Upon  removing  the  skin  and  superficial  cellular  meoibrane 
from  the  back  part  of  the^knee  joint,  we  shall  observe  the 
strong  fascia  which  covers  the  muscles  and  great  vessels  and 
nerves.  Upon  slitting  up,  and  dissecting  back  the  fascia, 
the  great  nerve  will  be  seen.  Below  the  nerve,  there  is 
much  cellular  membrane  and  fat,  and  under  this  fat,  and 
close  to  the  bone,  lie  the  popliteal  artery  and  vein.  They 
are  imbedded  in  this  tissue,  and  are  intimately  connected 
together;  the  vein  more  external,  and,  in  its  uninjected 


154 

state,  clinging  round  the  artery.  This  view  will  also  show 
us  how  difficult  it  will  be,  in  the  greater  number  of  cases,  to 
compress  the  artery  in  the  ham,  when  there  is  to  be  an  am- 
putation below  the  knee;  and  will  prove  the  necessity  of  ap- 
plying the  tourniquet  on  the  fore  part  of  the  thigh.  If  the 
parts  be  accurately  retained  in  their  natural  .situation  during 
dissection,  it  will  be  seen,  that  in  order  to  find  the  artery,  in 
operation,  our  incision  should  be  made  rather  towards  the 
outer  ham-string,  than  immediately  in  the  middle.  By  this 
means,  we  keep  to  the  outside  of  the  ischiatic  nerve.  We 
shall  find  the  artery  lying  deep,  and  covered  with  the  vein ; 
and,  to  tie  it  separately,  it  must  be  disentangled  from  under 
the  vein. 

It  will  perhaps  be  interesting  to  consider  the  change 
which  these  parts  undergo,  in  a  case  of  popliteal  aneurism. 

The  limb  is  generally  oedematous ;  sometimes  so  much  so, 
as  to  make  the  pulse,  at  the  inner  ankle,  to  be  felt  with  diffi- 
culty, independent  of  its  faintness,  from  the  aneurism.  The 
limb  is  often  considerably  bent.  Round  the  whole  knee 
joint,  there  is  much  swelling;  so  that  the  tumour  in  the  ham 
is  not  very  distinct,  but  has  more  the  feeling  of  general  ten- 
sion. Upon  laying  open  the  integuments,  the  tumour  comes 
more  distinctly  into  view,  distending  the  fascia. 

The  appearance  and  situation  of  the  parts,  particularly  of 
ihe  nerve  and  great  vein,  and  lesser  saphena,  will  depend 
upon  the  direction  in  which  the  coats  of  the  artery  first  give 
way.  If  the  artery  has  given  way  towards  the  inside,  then 
the  tumour  will  increase  in  that  direction  chiefly  ;  while  the 
artery  itself  will,  in  some  degree,  be  pushed  in  the  opposite 
direction,  and  the  nerve  and  the  vein  will  be  crowded  towards 
the  outer  ham-string. 

We  can  now  easily  understand  how  difficult  it  must  have 
been,  to  secure  the  ends  of  the  artery,  at  the  bottom  of  such 
a  tumour.  We  can  also  imagine  the  risk  of  secondary  he- 
morrhage, and  the  danger  of  violent  inflammation  of  the 
great  nerve,  in  consequence  of  the  extensive  suppuration 
which  must  follow  such  an  operation.  But  even  when  the 
operation  succeeded  the  limb  was  liable  to  remain  contract-, 
ed,  in  consequence  of  the  adhesion  of  the  parts. 

When  these  dangers  are  compared  with  the  consequences 
that  generally  follow  the  modern  operation, — we  cannot 
doubt,  as  to  which  we  should  choose.  But  the.  advantages 
of  the  modern  operation,  in  almost  every  case,  over  the  old 
method,  will  be  more  distinctly  shown,  by  the  relation  of  the 
following  case,  which  was  published  in  1809,  by  M.  Roux, 
in  his  "Melanges  de  Chirurgie  et  de  Physiologic. "  I  intro- 
duce it  here  not  only  to  lead  the  student  to  compare  the  sirn 


155 

plicitv  of  the  operations  on  the  arteries,  as  performed  by 
the  English  surgeons,  with  those  by  the  French,  but  also  as 
a  detail  which  may,  perchance,  be  useful, — as  I  have  seen  a 
case  of  popliteal  aneurism,  in  which  the  artery  should  have 
been  tied  in  the  ham.  The  operation  was  performed  in  the 
presence  of  MM.  Leroux,  Deschamps,  Boyer,  Dupuytren, 
&c.  and  the  account  of  it  is  introduced  by  the  following  eu- 
Jogy,  by  M.  Roux: — 

**  Could  we  unite  and  examine  all  the  cases  in  which  the 
operations  for  aneurism  have  been  successfully  performed, 
either  by  the  ordinary  method,  or  by  that  of  Hunter,  we 
should  find  few  where  the  operation  has  been  attended  with 
results  more  simple,  or  success  more  remarkable." 

"  A  tourniquet  was  placed  on  the  middle  of  the  thigh,  over 
the  course  of  the  femoral  artery,  and  a  stout  assistant  com- 
pressed the  artery  at  the  groin.  I  made  the  first  incision  of 
the  integuments  about  seven  inches  long.  The  second  inci- 
sion, through  the  aponeurosis,  exposed  the  sciatic  nerve, 
which,  though  immediately  attached  to  the  aneurismal  tu- 
mor, was  not  degenerated  or  flattened,  as  it  frequently  is.  It 
was  easy  to  pull  the  nerve  aside,  and  to  keep  it  under  the  ex- 
ternal edge  of  the  incision.  I  then  opened  the  tumour  par- 
allel to  the  course  of  the  popliteal  artery,  and  on  the  inner 
side  of  the  sciatic  nerve.  It  contained  a  quantity  of  liquid 
blood,  and  of  dense  clots,  which  adhered  firmly  to  the  walls 
of  the  cyst,  notwithstanding  the  short  duration  of  the  disease., 
These  clots  being  removed,  I  made  the  interior  of  the  ey&t 
perfectly  dry.  We  could  then  discover,  at  the  bottom  of  the 
wound,  the  opening  of  the  artery,  oprather  the  blood  flowing 
rrom  it,  when  the  tourniquet  was  relaxed  :  for  the  opening 
itself  was  not  very  apparent,  which  was  a  source  of  Fome 
difficulty  in  the  succeeding  steps  of  the  operation.  It  wa<s 
not  indeed  until  after  several  ineffectual  efforts,  that  I  w  as 
pnabled  to  pass  a  female  sound  into  the  opening,  with  the  in- 
tention of  lifting  the  artery,  and  facilitating  the  application 
of  the  ligatures.  This  instrument  was  directed  towards  the 
superior  part,  that  I  might  apply  the  two  upper  ligatures  ; 
after  which,  I  introduced  it  Into  the  lower  part,  as  far  as  the 
Kifurcation  of  the  popliteal  artery,  and  passed  under  it  two 
rtther  ligatures  ;  both  the  superior  and  inferior  ligatures 
were  introduced  by  the  assistance  of  the  needle  of  M.Des- 
Champs.  The  artery  was  tied  above  and  below  the  opening 
fcy  the  two  nearest  ligatures  ;  the  inferior  was  done  in  the 
Common  way,  by  two  nots  ;  but  for  the  superior,  I  made  use 
*f  another  instrument  of  M.  Deschamps,  known  by  the  name 
*>f  the  Presse  Artere  ;  by  the  aid  of  which,  the  artery  was 
Dot  puckered,  as  it  must  always  be  by  the  circular  ligature, 


156 

but  it  was"flattened  by  the  little  plate  which  forms  the  end  of 
the  instrument.  I  took  care  to  moderate  still  more  the  pres- 
sure upon  the  artery,  by  putting  under  the  plate  a  small 
piece  of  agaric,  secured  by  a  thread.  After  the  superior  and 
inferior  ligatures  were  applied,  the  tourniquet  was  relaxed  r 
the  blood  did  not  flow  from  the  opening  in  the  artery.  T 
then  proceeded  to  the  application  of  the  dressing.  The  liga- 
tures d'attente,  being  each  enveloped  in  a  piece  of  fine  linen, 
were  placed  at  the  angles  of  the  wound  ;  the  wound  was  fil- 
led lightly  with  charpie,  so  as  to  avoid  the  slightest  pressure, 
and  at  the  same  time  to  preserve  the  vertical  position  of  thfk 
presse  arlere"  &c. 

We  may  now  remove  the  skin  from  the  parts  below  the 
knee,  leaving  the  veins  and  small  nerves  upon  it. 

In  dissecting  the  veins,  we  should  consider  the.  diseases 
which  they  are  most  liable  to, — particularly  their  varicose 
state.  In  the  dissecting  room  we  shall  find  many  opportu- 
nities of  examining  varicose  veins,  and  proving  that  the  com- 
mon ideas  upon  this  disease  are  erroneous  ;  for  we  shall  find 
that  the  valves  are  not  destroyed,  but  that  the  coats  of  the 
veins  are  thickened,  so  as  to  prevent  the  valves  from  doing1 
their  office.  I  may  here  remark,  that  a  practice,  which,  a 
priori,  would  not  be  considered  good,  will  be  of  great  service 
in  relieving  the  varicose  state  of  the  veins,  and  the  ulcers  that 
are  a  consequence  of  it, — that  of  applying  a  spring  compress 
«ver  the  trunk  of  the  varicose  vein. 

In  dissecting  these  veins,  we  should  pay  particular  atten- 
tion to  their  relation  to  the  fascite, — that  we  may  not  be  foil- 
ed in  finding  them  at  once,  when  we  wish  to  cut  them  across* 

We  should  now  consider  what  will  be  the  best  method  of 
dissecting  for  the  anterior  and  posterior  tibial  arteries,  if  it 
should  be  necessary  to  tie  them. 

If  the  anterior  tibial  is  to  be  tied  high  in  the  leg,  the  inci- 
sion through  the  fascia  w^hich  covers  the  muscles,  must  be 
very  free,  because  the  artery  lies  very  deep.  By  then  dis- 
secting between  the  tiabilis  anticus  and  the  extensor  eommu- 
nis  digitorum,  the  artery  will  be  found  lying  upon  the  inte- 
rosseous  ligament,  accompanied  by  the  vena>  comites,  and 
almost  covered  by  the  nerve.  The  artery,  about  four  inches 
from  the  ankle,  will  be  found  between  the  tibialis  anticus 
and  extensor  longus  pollicis  ;  and  on  the  interior  part  of  th* 
foot,  between  the  extensor  communis  digitorum  and  the  ex- 
tensor longus  pollicis. 

The  posterior  tibial  may  be  found  about  the  middle  of  the 
leg,  by  first  detaching  part  of  the  origin  of  the  soleus  from 
the  -tibia,  and  then  by  freely  cutting  through  the  fascia  which 
cavers  the  deep  muscles  j  the  artery  will  then  be  seen,  a<- 


157 

c-ompanied  by  a  vien  on  each  side,  and  with  the  nerve  on  its 
fibular  edge.  It  is  an  extraordinary  circumstance  that  Mr. 
Hey,  of  Leeds,  has  advised  us  to  cut  out  a  piece  of  the  fibula, 
in  order  to  get  at  this  artery.  I  have  seen  a  patient,  on 
whose  leg  my  friend,  Mr.  Smith,  of  Leeds,  tied  the  artery, 
with  great  ease,  nearly  in  the  same  manner  which  I  have 
now  described.  When  there  is  a  deep  wound  in  the  sole  of 
the  foot,  it  may  be  necessary  to  tie  this  artery.  In  such  a 
case,  we  shoma  dissect  for  it  behind  the  inner  ankle.  The 
•  artery  will  be  found  under  the  fascia,  and  in  the  same  rela- 
tion to  the  nerve  as  it  is  higher  up;  but  the  quantity  of  fatty 
substance  which  is  here,  will  make  it  rather  difficult  to  ex- 
pose the  vessel. 

The  fibular  artery  may  be  found  at  two  hands'  breadth 
from  the  heel,  by  cutting  on  the  outside  of  the  gastrocnemi- 
us,  where  it  becomes  tendinous.  By  turning  up  the  edge 
of  the  tendon,  the  flexor  pollicis  magnus  will  be  exposed.  If 
the  fascia  which  covers  this  muscle  be  not  opened,  we  may 
perhaps  come  upon  the  posterior  tibial ;  but  by  opening  the 
fascia,  and  detaching  the  fibrous  origins  of  the  flexor  from 
the  fibula,  we  shall  find  the  artery  under  the  acute  margin  of 
the  bone,  accompanied  only  by  its  venaB  comites. 

After  having  attended  to  all  the  surgical  questions  con- 
nected with  the  anatomy  of  the  arteries,  we  should  consider 
of  the  most  eligible  positions  for  the  relaxation  of  the  mus- 
cles, in  the  different  kinds  of  fracture  ;  and  also  the  manner 
of  distinguishing  fractures  from  dislocations. 

When  we  open  the  joints,  we  shall  be  surprised  to  find  the 
great  number  of  instances  in  which  the  cartilages  of  the 
heads  of  the  bone  appear  eroded.  I  have  so  frequently  seen 
in  all  kinds  of  subjects,  (and  even  in  the  joints  of  animals,) 
the  appearance  wliich  is  described  by  Mr.  Brodie  as  ulcera- 
tion  of  the  cartilage,  that  I  cannot  agree  with  him  in  suppo- 
sing that  it  is  the  effect  of  disease.  I  rather  suspect  that  if 
is  a  change  which  very  frequently  takes  place  in  the  struct- 
ure of  the  cartilage,  without  any  symptoms  whatever  being 
f  he  consequence  of  it. 


DISSECTION 


UPPER  PART  OF  THE  BODY 


As  THE  upper  half  of  the  body  includes  all  the  parts  which 
are  above  the  diaphragm,  and  the  muscles  of  the  back,  it 
will  be  too  much  for  a  young  student  to  undertake  at  once  ; 
he  should  therefore  begin  with  an  arm,  or  one  side  of  the 
head.  But  as  these  two  parts  are,  according  to  the  rules  of 
the  dissecting  room,  generally  taken  by  the  same  student,  I 
shall  lay  down  a  plan  of  such  a  series  of  dissections  as  will 
enable  him  to  make  the  most  of  these  parts,  and  which  will, 
at  the  same  time,  be  practicable  while  several  pupils  are  en- 
gaged in  dissecting  the  same  body. 

As  the  student  should  dissect  those  parts  first  which  be- 
come soonest  putrid,  he  ought,  on  the  first  day,  in  union  with 
his  companion,  to  attempt  to  make  a  dissection  of  the  princi- 
pal parts  of  the  brain.* 

On  the  second  day,  he  should  dissect  the  superficial  mus- 
cles of  the  neck  ;  and  on  the  third  day,  the  muscles  of  the 
face.  On  the  fourth  day,  he  may  examine  the  deep  muscles 
of  the  throat  and  of  the  jaw,  and  the  general  anatomy  of  the 
mouth. 

This  plan  may  be  very  easily  followed  if  the  student  can 
turn  the  body  as  he  pleases  ;  but  as  I  have  supposed  that 
there  is  another  pupil  engaged  in  dissecting  the  opposite  s  de 
of  the  head,  his  operations  must  also  be  taken  into  considera- 
tion. 

As  it  will  be  very  inconvenient  for  both  students  to  dissect 
the  neck  at  the  same  time,  they  must  either  dissect  at  differ- 
ent hours,  or  one  must  pursue  the  dissections  of  the  arm, 
while  the  other  is  engaged  with  the  neck.  But  if  both  art 
young  dissectors,  the  best  plan  will  be,  for  the  one  to  assist 

*  Neither  the  arteries  nor  the  veins  should  be  injec.ted> 


159 

the  other,  as  the  dissection  of  the  neck  is  very  difficult  for  a 
beginner. 

The  muscles  on  the  fore  part  of  the  chest  should  be  next 
dissected,  and  then  the  thorax  may  be  opened,  so  that  a  gen- 
eral view  of  the  viscera  may  be  given  ;  after  which,  the  heart 
and  lungs;  with  the  larynx,  &c.  should  be  removed,  and  put. 
into  water,  for  future  examination. 

At  this  stage  of  the  dissection,  the  students  who  are  dis- 
secting the  lower  half,  will  probaly  be  prepared  either  to 
make  a  section  of  the  body,  or  to  turn  it.  The  superficial 
muscles  of  the  back  are  then  to  be  dissected.  When  these 
are  finished,  the  arm  should  be  separated  from  the  trunk,  by 
cutting  through  those  muscles  of  the  back  and  chest,  which 
are  inserted  into  the  scapula,  and  by  either  dislocating  the  clav- 
icle from  the  sternum,  or  by  cutting  it  through  the  middle. 
The  arm  should  be  wrapped  up  in  a  damp  cloth,  and  laid  in  a 
cool  place,  until  the  dissection  of  the  other  part  is  finished. 

The  deep  muscles  of  the  back  and  of  the  fore  part  of  the 
nock  should  now  be  dissected.  The  vertebra?  are  then  to  be 
divided,  so  that  the  ligaments  may  be  examined. 

If  the  student  does  not  wish  to  preserve  the  scull,  he 
should  make  such  sections  of  it  as  will  enable  him  to  show  the 
general  anatomy  of  the  nose,  ear,  &c.  But  before  he  exam- 
ines these,  or  dissects  the  ligaments,  he  should  allow  them  to 
remain  in  water  for  some  time  :  in  the  mean  time  he  may 
dissect  the  muscles  of  the  arm.  After  the  muscles  of  the 
arm  are  dissected,  he  should  examine  the  ligaments. 

In  the  second  dissection  of  the  upper  half  of  the  body,  the 
arteries  (having  been  previously  injected)  should  be  traced, 
with  some  of  the  principal  nerves  and  veins.  During  this  dis- 
sertion,  the  student  should  attend  to  the  practical  points  of 
surgery  ;  but  another  body,  in  which  the  vessels  are  unin- 
jected,  should  also  be  devoted  to  this  examination. 

In  the  third  dissection,  the  brain  and  nerves  should  be  more 
ijfirlv  studied. 


160 

DISSECTION 

OF 

THE BR 


I  SHALL  at  present  describe  only  the  common  method  of 
dissecting'  the  brain  ;  for,  whatever  changes  may  take  place 
in  our  opinions  regarding  the  nervous  system,  it  will  be  al- 
ways necessary  to  be  familiar  with  the  natural  appearances 
of  the  different  parts  of  the  brain,  when  it  is  dissected  from 
above,  downwards, — because  this  has  been  the  method  gen- 
erally pursued  in  tracing  the  effects  of  disease  or  injury  upon 
the  brain. 

I  think  that  the  student  will  derive  much  advantage  by 
dissecting  the  brains  of  the  lower  animals;  because  he  will 
not  only  discover  the  meaning  of  certain  names  which  are 

fiven  to  parts  of  the  brain,  but  he  will  also  find  it  to  be  the 
est  and  most  interesting  mode  of  investigating  the  anatomy 
in  a  physiological  point  of  view.  After  he  is  familiar  with 
the  dissection  of  the  brain  of  the  pig,  sheep,  &c.  he  will  be 
able  to  make  the  dissection  of  the  human  brain  in  a  variety 
of  ways. 

To  prepare  for  the  dissection  of  the  brain,  the  scalp  should 
be  cut  in  the  line  of  the  coronal  suture,  from  ear  to  ear;  then 
the  anterior  portion  is  to  be  raised  from  the  scull,  and  pulled 
down  upon  the  face ;  the  posterior  part  should  be  carried  to- 
wards the  occiput.  It  is  necessary  to  follow  this  plan  in  a 
private  dissection ;  for,  unless  we  do  so,  we  shall  find  some 
difficulty  in  making  the  parts  appear  decent  after  the  dissec- 
tion is  finished. 

In  cutting  through  the  scull,  there  is  some  nicety  requir- 
ed. It  should  not  be  cut  lower  down,  on  the  anterior  part, 
than  half  an  inch  above  the  frontal  sinuses; — but  the  cut 
may  be  carried  to  a  lower  level  behind.  Before  the  saw  is 
applied,  a  piece  of  whip-cord  should  be  tied  firmly  round  the 
scull,  as  a  mark  for  the  circular  incision.  The  saw  should 
not  be  carried  through  all  the  tables  of  the  scull ;  but  after 
having  cut  through  the  external  and  middle  tables,  we  should 
endeavour  to  break  through  the  tabula  vitrea,*  with  the 

*It  is  hardly  necessary  for  me  to  remind  the  student,  that 
in  the  child,  the  tables  of  the  scull  are  not  developed  ;  and 


161 

vln^I  and  mallet ; — by  proceeding  thus,  the  dura  mater  will 
probably  not  be  cut, — which  it  is  very  difficult  to  avoid,  if  all 
the  tables  be  sawed  through.  Although  the  bone  may  be 
completely  divided,  it  will  still  be  very  difficult  to  raise  the 
scull-cap,  in  consequence  of  the  firm  union  which  there  is  be- 
tween it  and  the  Dura  Mater.  This  forms  an  important 
point  of  demonstration, — for  it  proves,  that  part  of  the  dura 
mater  is  the  internal  periosteum.  This  is  well  exemplified 
in  the  scull  of  a  child ;  for  there,  it  will  be  found  impossible 
to  raise  the  scull-cap,  without,  at  the  same  time,  cutting  the 
dura  mater  ; — even  in  the  adult,  it  is  necessary  to  use  a  lever 
between  the  portions  of  the  scull,  and  then  to  pull  it  up,  with 
some  violence,  before  it  will  separate  from  the  dura  mater. 
When  the  adhesion  is  particularly  strong,  the  separation 
may  be  facilitated  by  passing  a  whale-bone  spatula,  or  the 
handle  of  the  knife,  between  the  dura  mater  and  the  bone. (a) 

When  the  scull-cap  is  torn  off,  we  shall  see  pits  and  fur- 
rows upon  its  inner  surface, — and,  on  the  dura  mater,  little 
fungous  excrescences  and  vessels,  corresponding  to  the  pits 
and  furrows  in  the  bone.  Tho  fungi  are  most  numerous  on 
the  parts  opposite  to  the  sagittal  suture ;  they  are  like  soft 
warts,  or  pale  granulations,  and  have  been  called  Glowl-ufo 
Pacchiofii.  If  the  arteries  have  been  injected,  the  branches 
of  the  Meningea  Media  will  be  seen.  The  Anterior  and 
Posterior  Meningeal  arteries  are  so  small,  that  they  will  not 
be  visible,  until  the  brain  is  removed. 

If  we  make  a  puncture  with  the  scissors  into  the  most  su- 
perior and  central  part  of  the  dura  mater,  we  shall  pierce  the 
.Longitudinal  Sinus.  If  we  pass  a  probe  into  this  puncture, 
it  may  be  pushed  towards  the  occiput,  and  towards  the  fron- 
tal bone, — thus  showing  the  course  of  the  sinus. 

The  sinus  may  be  opened,  by  cutting  upon  the  probe. — 
The  first  thing  we  shall  observe  in  the  sinus,  is  a  body  ge- 
nerally of  a  white  colour ;  but  which,  we  shall  find  to  be 
only  a  coagulum,  that  has  taken  the  form  of  the  sinus.  The 
internal  surface  of  the  sinus  is  irregular,  in  consequence  of 
*  here  being  frequently  many  of  the  glandular  Pacchioni  in  it ; 
and,  from  its  being  crossed  by  a  number  of  small  filaments. 

that,  in  extreme  old  age,  they  are  all  consolidated,  it  is  only 
in  the  adult,  that  the  three  tables  are  distinct. 

(a)  The  adhesion  between  the  dura  mater  and  the  inner 
table  of  the  skull  is  from  blood  vessels  entering  the  bone  at 
every  point,  and  from  processes  of  the  membrane  passing  out 
a H he  sutures  to  communicate  with  the  pericranium. 


162 

which,  as  well  as  a  set  of  bands  that  are  situated  on  the  out- 
side of  the  sinus,  have  been  called  the  Cordce  Willisii.  By 
putting  the  probe  under  one  of  these  cords,  we  shall  probably 
pass  it  into  the  mouth  of  one  of  the  veins  which  enter,  in  a 
lateral  direction,  from  the  pia  mater. — We  cannot  prosecute 
the  course  of  the  sinuses  farther,  in  this  stage  of  the  dissec- 
tion. 

Our  next  step  must  be,  to  raise  the  dura  mater ;  to  do  this, 
we  should  cut  through  it  opposite  to  the  ear,  on  both  sides, 
and,  with  the  scissors,  carry  the  incision  forwards  nearly  to 
the  spine  of  the  frontal  bone, — and  on  the  back  part,  to  the 
perpendicular  ridge  of  the  occipital  bone.  The  lateral  part* 
of  the  dura  mater,  may  then  be  turned  up  towards  the  longi- 
tudinal sinus ;  this  will  expose  the  substance  of  the  brain, 
covered  by  the  Tunica  JLrachnoides  and  Pia  Plater.  In  do- 
ing this,  no  adhesions  will  be  found  between  the  dura  mater 
and  the  oths.r  membranes,  except  at  an  inch,  or  half  an  inch,- 
from  the  sinus.  This  adhesion  has  a  white,  granulated  ap- 
pearance, which  has  often  been  described  as  the  effect  of 
disease.  When  we  tear  this  up,  we  shall  see  the  veins  of 
the  brain  entering  into  the  sinus ;  and  by  breaking  down  the 
connections  on  both  sides,  we  may  see* that  prolongation  of 
the  dura  mater,  which  is  called  the  Falx,  and  which  sepa- 
rates the  upper  part  of  the  brain  into  Two  Hemispheres; 
and  by  merely  pulling  aside  the  masses  of  the  brain,  and  pass- 
ing down  the  handle  of  a  knife  between  the  hemispheres,  we 
may  expose  this  septum,  in  all  its  length.  On  its  anterior 
part,  we  shall  see  that  it  is  very  narrow,  and  that  it  is  attach- 
ed to  the  crista  galli  of  the  ethmoid  bone ; — as  it  passes  back, 
-it  is  seen  to  increase  in  depth,  until  it  becomes  attached  to 
the  Tentorium;  but  the  tentoriurn  cannot  be  seen  in  this 
view, — nor  until  a  considerable  part  of  the  brain  is  removed. 
The  scissors  should  now  be  passed  between  the  anterior  part, 
of  the  hemispheres,  so  as  to  divide  the  connection  between 
the  falx  and  crista  galli ;  the  falx  may  then  be  pulled  toward? 
the  occiput,  as  a  few  small  vessels  are  the  only  means  of  ad- 
hesion between  it  and  the  brain.  The  dura  mater  having; 
been  thus  laid  down  towards  the  occiput,  we  may  examine 
the  next  membrane — Tunica  ArachnMea.  If  there  be  no 
effusion  of  serum  on  the  surface  of  the  brain,  it  will  be  diffi- 
cult to  see  the  membrane,  on  account  of  its  transparency;  but 
when  there  is  effusion,  the  membrane  will  be  apparent,  with-" 
out  any  -preparation, — as  the  membrane  will  then  be  gener- 
aMy  a  little  thickened.  To  show  it,  in  all  cases  it  is  only  ne- 
cessary to  make  such  a  puncture  on  the  surface,  as  will  ad- 
mit the  point  of  the  blow-pipe, — the  air  will  raise  it  in  the 
form  of  vesicles.  It  is  difficult  to  trace  this  membrane  to  ali: 


163 

Ui<-  parts  of  the  brain  that  it  is  said  to  go  to.  It  is  easy  to 
trace  it  over  the  surface,  passing  from  one  convolution  to 
another,  without  dipping  between  them,  as  the  pia  mater  will 
be  found  to  do.  But  it  is  said  to  be  reflected  on  the  inner 
surface  of  the  dura  mater,  so  as  to  give  it  its  glistening- 
smooth  appearance ;  and  it  is  also,  by  the  French  theorists 
described  as  passing  into  the  ventricles,  so  as  to  cover  their 
internal  surface. — When  the  base  of  the  brain  is  exposed, 
the  membrane  will  be  seen  to  be  much  thicker  at  that  part. 

The  next  membrane,  the  Pia  Mater,  is  so  distinctly  seen 
through  the  last,  that  they  have  often  been  confounded.  We 
see  it  loaded  with  arteries  and  veins, — and  when  we  pull 
upon  a  portion  of  it,  we  shall  find  that  it  goes  down  into  the 
substance  of  the  brain,  and  that  it  passes  between  the  con- 
volutions.— In  the  course  of  our  dissection,  we  shall  discover 
the  pia  mater  in  many  parts  of  the  interior  of  the  brain, — it 
being,  in  fact,  the  cellular  membrane  which  supports  the 
palp,  and  carries  the  several  parts. 

We  should  now  tear  this  membrane  from  one  of  the 
hemispheres,  so  as  to  show  the  convolutions.  The  surface 
of  these  convolutions  will  appear  grey :  but  if  we  cut  a  slice 
off,  we  shall  then  see  that  the  interior  is  of  a  white  colour, 
from  this  circumstance,  the  surface  has  been  called  the  Cine- 
ritious,  or  Cortical  Part, — and  the  internal,  the  Central,  or 
Medullary. 

We  should  now  separate  the  two  hemispheres  gently  from 
each  other,  and  then,  by  looking  down  between  them,  we 
shall  see  a  white  mass, — and  if  the  arteries  have  been  inject- 
ed, two  arteries  will  be  perceived  upon  it :  this  white  mass 
has  been  called  the  Corpus  CallowmfoT,  from  the  term  Com- 
missure  being  given  to  the  points  of  union  between  the  se- 
veral parts  of  the  brain,  it  has  been  called  Commissura  Mag- 
na,  as  being  the  largest. 

As  we  have  nothing  particular  to  remark  in  the  structure 
of  the  upper  part  of  the  hemispheres,  they  may  be  gradually 
sliced  down,*  until  we  reach  the  level  of  the  corpus  callo- 
sum.  In  making  these  cuts,  the  relative  disposition  of  the 
cmeritious  and  medullary  matter  will  be  seen  to  vary :  about, 
an  inch  and  a  half  from  the  surface  of  each  hemisphere,  the 
medullary  matter  will  have  an  oval  form,  and  be  surrounded 
by  a  band  of  cineritious  matter ;  this  is  called  the  Centrum 
Ouale  Parvum  of  Vicq-d'Azyr,  and  must  not  be  confounded 
with  the  proper  Centrum  Ovate  of  Vieussens,  which  will  be 

*  In  slicing  the  brain,  we  shall  find  that  it  will  be  done 
with  more  ease,  if  we  occasionally  dip  the  knife  into  water. 


164 

seen  when  both  hemispheres  are  cut  down  nearly  to  a  leve! 
with  the  corpus  callosum,  —  which  we  should  now  do.  But 
we  ought  not  to  be  too  anxious  to  show  this,  exactly  as  an 
oval  ;  for,  in  doing  so,  we  may  cut  so  deep,  as  to  open  the 
Lateral  Ventricles,  if  they  should  be  distended  with  fluid. 
When  this  part  has  assumed  the  appearance  of  a  large  oval 
of  medullary  matter,  we  shall  see,  in  the  centre  of  it,  the 
Corpus  Callosum,  —  and  in  the  middle  of  this,  there  is  a  little 
furrow  called  Raphe,  or  Suture,  which  is  formed  by  two  lon- 
gitudinal ridges,  running  betv/een  the  anterior  and  posterior 
part  of  the  brain.  By  examining  the  part  closely,  we  may 
discover  the  fibres  which  run  across,  and  are  termed  L'micf 


Our  next  object  is,  to  open  the  Lateral  Ventricdles.  This 
may  be  very  easily  done,  if  there  be  water  in  them  ;  for  we 
have  only  to  slice  down  the  medullary  matter,  horizontally. 
on  each  side  of  the  corpus  callosum,  until  the  water  flows 
out  ;  but  we  should  preserve  about  a  half,  or  three  quarters 
of  an  inch  in  breadth  of  the  corpus  callosum,  through  its 
whole  extent.  It  will  be  rather  difficult  to  know  when  the 
Ventricle  is  opened,  if  there  be  no  water  in  it  (and  this  may 
be  ascertained,  by  patting  with  the  finger,  on  each  side  of  the 
corpus  callosum,)  because  the  first  part  which  will  be  seen, 
when  the  ventricle  is  laid  open,  is  a  grey  mass;  there  being 
as  yet  no  appearance  of  a  cavity.  But  by  insinuating  a 
probe,  or  the  handle  of  a  knife,  between  this  body  (which  is 
the  upper  part  of  the  Corpus  Striatimi]  and  the  cut  margin 
of  the  medullary  matter,  we  shall  be  able  to  pass  it,  towards 
the  frontal  bone,  into  the  cavity  in  the  anterior  lobe,  and 
then  into  that  in  the  posterior  lobe.  If  the  brain  be  firm, 
we  may  expose  the  cavities,  by  cutting  upon  the  probe,  or 
by  taking  out  a  piece  with  the  scissors  ;  but  the  brain,  when 
examined  in  the  dissecting  room,  is  generally  so  soft,  that  a 
knife,  introduced  like  a  bistoury,  upon  the  probe,  is  sufficient 
to  tear  the  medullary  matter,  —  still  we  ought  not  to  do  this,  it' 
we  can  avoid  it.  Wnen  both  ventricles  are  opened  in  the  same 
manner,  we  can  understand  how  the  corpus  callosum  is  said 
to  form  the  roof  of  the  ventricles  ;  for  it  is  now  seen  to 
.stretch  from  the  anterior  to  the  posterior  part,  in  the  form  of 
an  arch.  If  the  brain  be  tolerably  firm,  we  may  be  able  to 
see  the  septum  of  the  ventricles,  which  is  formed  by  a  thin 
lamina  of  medullary  matter  that  passes  down  perpendicular- 
ly from  the  lower  surface  of  the  corpus  callosum,  towards  the 
Jloor  of  the  ventricle,  and  which  we  shall  afterwards  find  to 
be  formed  by  the  Fornix.  In  consequence  of  this  portion  of 
medullary  matter  forming  a  transparent  septum  between  the 
right  and  left  ventricles,  it  has  been  called  the  Septum  Lwd- 


163 

dum.  But  we  shall  very  seldom  get  a  brain  sufficiently  firm, 
to  allow  of  the  septum  being  seen. 

A  small  slip  of  writing  paper  should  now  be  cut  to  the 
shape  of  the  corpus  callosuin,  and  laid  on  its  upper  surface  ; 
this  will  give  the  corpus  callosuin  such  a  degree  of  firmness, 
that,  after  having  cut  it  through  at  its  anterior  part,  we  shall 
be  enabled  to  tear  it  back  ;  in  doing  this,  the  septum  lucidum 
is  necessarily  destroyed, — but  we  may  observe,  that,  as  it  is 
torn,  it  separates  into  two  laminae,  that  appear  to  have  a  ca- 
vity between  them,  and  which  has  been  called  the  Fifth  Ven- 
tricle. 

When  the  corpus  callosum  is  laid  back  as  far  as  its  con- 
nection with  the  medullary  matter  of  the  posterior  lobe,  th«* 
Fornix  will  be  seen,  connected  to  the  medullary  matter  ot 
the  anterior  lobe,  and  branching  into  two  portions  behind. 
Biit,  in  tearing  back  the  corpus  callosum  and  septum  luci- 
dum,  in  a  soft  brain,  we  are  very  spt  to  tea*  up  a  portion  of 
the  fornix,  just  at  the  point  of  its  division,  and  thus  to  make 
the  appearance  of  a  hole  in  it. 

Before  tracing  the  fornix,  we  should  attend  to  the  general 
form  of  the  lateral  ventricles.  The  cavities  which  have 
been  already  exposed,  are  called  the  Anterior  and  Posterior 
Horns  or  Sinuses  ;  but  there  is  yet  another  sinus,  which  is 
called  the  Inferior  or  Middle  Hern.  This  last  should  now 
be  laid  open  ;  but  as  it  lies  very  deep  in  the  middle  10be,  it 
will  be  necessary  to  cut  away  a  large  quantity  of  the  brairr. 
before  we  can  show  it.  The  knife  may  be  placed  oft  the  up- 
per part  of  the  corpus  striatum,  and  carried  in  a  slanting  di- 
rection, towards  the  angle  formed  by  the  union  of  the  squa- 
mous  and  petrous  portions  of  the  temporal  bone;  and  it  may- 
be continued,  in  the  same  line,  from  the  anterior  to  the  pos- 
terior part  of  the  brain.  Even  this  large  cut  may  not  be 
sufficient  to  expose  the  inferior  sinus;  but  in  cutting  more, 
we  must  proceed  cautiously.  The  Posterior  CVmofthe 
fornix  will  direct  us  to  the  opening  of  the  sinus;  we  should; 
pass  a  probe,  or  the  handle  of  a  knife  along  the  crus,  and 
then  cut  upon  it ;  but  as  the  sinus  takes  a  sweep  like  a  ram's 
horn,  the  turn  must  be  cautiously  followed.  When  the  cavi- 
ties of  both  sides  are  exposed  in  their  full  extent,  we  may 
make  our  observations  on  the  several  parts  which  are  in  the 
two  ventricles. 

We  at  once  recognize  the  Corpora  Striata  ;  for  the  incis- 
ions which  have  been  made  for  the  exposure  of  the  inferior 
horns,  exhibit  the  mixture  of  cineritious  and  medullary  mat- 
ter, from  which  these  bodies  have  got  the  name  of  corpora 
striata.  We  may  now  see  that  the  Fornix  is  attached  to  the 
anterior  lobe  of  the  brain,  by  a  part  which  appears  single,  but 


166 

which,  we  shall  afterwards  discover  to  be  formed  of  two 
cords  :  however,  this  is  generally  called  the  Anterior  Cms  of 
the  Fornix.  If  we  trace  the  fornix  backwards,  we  shall  see 
it  dividing  into  two  parts,  which  are  called  its  Posterior  Cru- 
ra,  and  which  diverge,  and  descend  into  the  inferior  horns. — 
Between  the  fornix  and  the  corpora  striata,  a  reddish  body 
will  be  seen  ;  this  is  part  of  the  Plexus  Choroides,  which  may 
be  traced  into  the  posterior  horn,  and  also  into  the  deepest 
part  of  the  inferior  horn:  where  it  will  be  afterwards  found 
to  communicate  with  the  pia  mater  which  covers  the  base  of 
the  brain.  If  we  now  look  into  the  posterior  horn,  we  shall 
see  a  little  medullary  eminence,  which  has  been  called  Hip- 
pocampus Minor,  to  distinguish  it  from  a  much  larger  emi- 
nence, of  the  same  kind,  which  is  in  the  inferior  horn,  and  is 
called  Hippocampus  Major,  from  some  resemblance  which  it 
has  to  a  small  marine  animal.  If  we  pull  up  the  portion  of 
the  plexus  which  descends  into  the  inferior  horn,  we  shall 
see,  that  the  hippocampus  takes  a  turn  somewhat  like  a  ram's 
horn,  whence  it  has  sometimes  received  the  name  of  Cornu 
Ammonia  ;  its  extremity  has  a  bulbous  form,  like  the  point  of 
a  finger,  whence  it  is  occasionally  called  Digital  Process,  and 
the  extremity  of  the  sinus,  the  Digital  Cavity.  At  the  first 
view,  the  hippocampus  appears  to  be  the  continuation  of  the 
posterior  crus  of  the  fornix  ;  but,  by  following  the  crus,  we 
shall  find  that  it  terminates  in  a  thin  layer  of  medullary  mat- 
ter, which  lies  on  the  hippocampus  :  as  this  layer  ^has  soimr 
resembfance  to  a  tape  worm,  it  has  been  called  Twnia,  and 
to  distinguish  it  from  another  taenia,  it  is  called  Tcenia  Hip- 
pocampi, or,  from  its  edge  being,  when  in  a  fresh  state,  appa- 
rently fringed,  it  has  also  got  the  name  of  Tcenia  Fimbriata. 
We  should  now  examine  the  communication  which  there 
is  between  the  two  ventricles:  If  we  trace  the  plexus  cho- 
roides,  we  shall  find  it  inclining  towards  the  anterior  crus  of 
the  fornix  :  if  we  then  pass  a  curved  probe,  or  small  bougie, 
along  the  plexus,  and  under  the  anterior  crus  of  the  fornix,  if 
will  appear  in  the  opposite  ventricle.  But  it  may  be  object* 
ed  to  tltis, — that  the  brain  is  so  soft,  that  the  probe  would 
meet  with  no  resistance,  were  it  to  be  passed  through  the 
matter  of  the  fornix.  The  best  proof  we  have  of  the  exis* 
tence  of  a  hole  here,  is  by  blowing  on  one  side  of  the  crus  of 
the  fornix,  for  the  air  will  then  pass  into  the  other  ventricle  , 
or  if  we  open  the  right  ventricle,  in  a  very  fresh  brain,  and  lay 
the  head  on  the  same  side,  the  water  will  flow  from  the  left 
ventricle  through  the  hole.  In  cases  of  hydrocephalus,  wre 
shall  sometimes  find  the  hole  large  enough  to  admit  the  point 
of  the  finger.  This  opening  has  been,  by  some,  called  the 
Foramen  of  Monro ;  but  it  is  more  generally  called  the  For- 


167 

amen  Commune  Anterivs, — as  we  shall  afterwards  find,  thai 
if,  also  communicates  with  the  third  ventricle^  and  with  the 
Jnfundibulum, 

The  fornix  may  now  be  cut  at  the  point  under  which  the 
probe  has  been  passed,  and  may  then  be  turned  back  ;  but  as 
the  substance  of  the  fornix  is  very  soft,  it  should  be  strength- 
jnned  by  putting  a  piece  of  paper,  of  the  same  shape,  upon  it. 
When  the  fornix  is  thrown  back  as  far  as  the  point  where  it 
diverges,  we  may  perceive  upon  its  lower  surface,  white  lines, 
something  in  the  form  of  the  strings  of  a  lyre  ;  from  this  ap- 
pearance, the  lower  part  has  got  thenameofiyra. 

We  shall  now  have  a  complete  view  of  the  plexus  choroi- 
des  of  each  side,  united  together  by  a  membrane  which  is  ge- 
nerally called  Velum  Interpoxitum  or  Velum  Vnsculosum^ — 
or,  from  its  similarity  to  the  mesentery  of  the  intestines,  me- 
sentery of  the  plexus  choroides.  In  the  fresh  and  sound  brain, 
the  plexus  and  its  velum  will  prevent  us  from  seeing  any  of 
the  Tkalamus  which  is  below  it ;  but  it  generally  happens, 
that  the  plexus  of  each  side  falls  towards  the  middle,  so  as 
to  expose  a  part  of  both  thalami. 

If  we  examine  the  middle  of  the  plexus,  we  shall  see  two 
veins  passing  backwards,  to  unite  and  form  a  larger  one, — 
the  Vena  Gal  mi.  We  may  trace  this  vessel  back,  by  making 
it  horizontal  cut,  on  the  level  of  the  velum,  quite  to  the  occi- 
put, so  as  to  remove  all  the  remaining  parts  of  the  fornix  and 
corpus  callosum  :  the  vein  will  then  be  seen  entering  into 
the  fourth  sinus  of  the  dura  mater,  or  Torcular  Hierophi/i. 
which  is  just  at  the  union  between  thefalx  and  tentorium. 

We  should  now  raise  the  plexus  choroides  and  velum  from 
the  anterior  part,  and  carry  it  back  ;  but  at  first,  we  should 
not  remove  it  farther  than  two  inches.  This  will  complete- 
ly expose  the  two  white  bodies  which  are  called  TKalumi  JVe- 
vorum  Opticorum.  Upon  their  anterior  part,  we  may  see 
two  little  eminences,  called  the  Monticuli  ;  and  in  the  angles 
of  union  between  the  thalami  and  corpora  striati,  we  shall 
see  a  streak  of  whitish  matter,  which  has  somewhat  the  form 
of  a  tape- worm,  or  piece  of  tape,  whence  it  is  called  Tasnia  ; 
and,  from  its  direction,  semicircularis  ;  and  from  its  connex- 
ion with  the  thalami,  which  are  sometimes  called  gemini,  if 
has  the  word  geminum  added, — Tcenia  Semwircularis  Gemi- 
num. 

On  the  anterior  part  of  the  thalami,  we  shall  seethe  open- 
ing which  has  already  been  described  as  forming  part  of  the 
foramen  commune  anterius,  If  we  direct  a  probe  slantingly 
forwards,  it  will  pass  towards  the  part  called  Her  ad  infimdi- 
bulum ;  if  pushed  on,  it  would  pass  through  the  substance  of 
the  infundibulum,  and  enter  ihe  Pituitary  Gland.  If  the 


168 

probe  b«  pulled  out,  and  then  passed  downwards  and  back- 
wards, it  will  pass  into  the  Third  Ventricle.  This  open- 
ing has  sometimes  received  the  elegant  name  of  Vulva  > 
while  the  depression  which  may  be  now  seen  at  the  other  ex- 
tremity of  the  thalami,  has  got  the  name  of  Anus.  Thislat' 
ter  opening  is  sometimes  called  foramen  commune  posterius ; 
but  it  differs  from  the  anterior  opening  in  this,  that  it  is  so 
covered  by  the  velum  interpositum,  that  there  is  no  opening 
here  until  the  velum  is  torn  up. 

We  may  now  trace  the  plexus  choroides  a  little  more. 
We  shall  find  that  it  dips  down  behind  the  anus  ;  but  we 
must  be  careful  how  we  raise  it  at  this  part,  for  here  it  sur- 
rounds the  Pineal  gland ; — therefore,  the  membrane  shouJd 
not  be  rudely  pul-led  away,  but  should  be  dissected  off  with 
the  forceps  and  scissors  ;  by  which  we  shall  expose  a  little 
reddish  grey  body,  rather  larger  than  a  pea,  and  attached  to 
the  posterior  part  of  each  thalamus,  by  a  little  process  or  pe- 
duncle ;  this  is  the  famous  Pineal  Gland.  When  we  take  it 
between  our  fingers,  we  must  not  be  surprised  to  find  some 
gritty  particles  in  it. 

We  should  now  separate  the  tXalami  gently  from  each  oth- 
er, and  we  shall  find  that  they  are  united  by  a  grey  mass, 
which  is  called  the  Commissura  Mollis.  The  name  implies, 
that  this  bond  of  union  will  be  often  dissolved  before  we 
reach  this  part  of  the  dissection.  The  chink,  or  sulcus, 
which  is  seen  on  separating  the  thalami,  is  the  Third  Ven- 
tricle. If  we  separate  the  thalami  to  some  distance  from 
each  other,  and  look  towards  the  anterior  part  of  the  cavity, 
we  shall  see  a  white  cord  passing  across  it  :  this  is  called 
the  Comnnssura  Anterior  ; — we  may  see  a  similar  cord  on 
the  posterior  part,  called  the  Commissura  Posterior  ;  but  to 
see  these,  and  the  third  ventricle,  more  distinctly,  we  should 
now  slice  away  a  great  part  of  the  thalami  and  corpora  striata. 
The  next  point  of  demonstration  is  the  Nates  and  Tester, 
or  Tuhercula  Qwidragemma.  It  is  rather  difficult  to  expose 
these,  as  they^are  situated  in  the  space  between  the  cerebrum 
and  cerebellum.  All  the  part  of  the  posterior  lobe  which  is 
lying  on  the  tentorium,  should  be  removed,  and  then  the  ten- 
torium  should  be  cut  through  on  each  side,  so  as  to  expose 
the  upper  part  of  the  cerebellum, — the  projecting  part  of 
which  (processus  vermiformis  superior)  is  to  be  held  down  ; 
the  four  little  eminences  will  then  be  seen  ;  the  two  superior 
being  called  the  Nates, — the  inferior,  the  Teate-s. 

The  next  stage  of  the  dissection  is  difficult ;  for  we  ought 
now  to  expose  the  cavity  of  the  Fourth  Ventricle,  which  fies 
between  the  cerebellum  and  medulla  oblongata.  If  we  'pass 
a  probe,  slightly  curved,  from  the  third  ventricle,  under  tire 


169 

posterior  commissure,  and  give  it  a  direction  downwards  and 
backwards,  it  will  pass  into  the  fourth  ventricle,  the  passage 
being  called  Iter  a  Tertio  ad  Quartum  Ventriculum,  or  by  the 
old  name  ofAquce  Ductus  Syivii.  If  we  hold  back,  or  slice 
away,  the  upper  part  of  the  cerebellum,  and  raise  the  probe, 
we  may  perceive  it  under  at  hin  lamina  of  medullary  matter^ 
which  is  the  roof  of  the  fourth  ventricle,  and  is  sometimes  cal- 
led falvufa  Cerebri,  or  Valvula  Vieussenii ;  by  cutting 
through  this,  we  may  look  into  the  cavity  of  the  fourth  ven- 
tricle :  and  now  we  may  observe,  that  this  valvula  cerebri  is 
connected  with,  or  formed  of  two  cords,  running  from  the 
nates  and  tostes  to  the  cerebellum;  these  cords  are  each  cal- 
led Processus  a  Cercbello  ad  Testes. 

There  are  two  or  three  different  modes  of  exposing  the  ca- 
vity of  the  fourth  ventricle  more  fully.  One  way  is,  to  car- 
ry the  knife  down  perpendicularly,  so  as  to  divide  the  cere- 
belluqjpnto  two  portions  ;  but  the  best  way  of  examining  it, 
is  to  cut  out  a  triangular  portion  of  the  occipital  bone,  down 
to  nearly  as  far  as  the  foramen  magnum.  When  the  bone 
is  removed,  we  shall  see  the  cerebellum  connected  at  the 
lower  part,  by  the  pia  mater,  to  the  beginning  of  the  spinal 
marrow  ; — this  portion  of  membrane  is  the  only  boundary 
which  the  fourth  ventricle  has  on  its  lower  part,  so  that  it" 
we  tear  it,  we  shall  open  the  cavity.  By  lifting  the  cerebel- 
lum, we  shall  expose  the  sulcus  on  the  upper  part  of  the  spi- 
nal marrow,  which  has  been  called  the  Calamus  Scriptorium ; 
then,  by  dividing  the  cerebellum  vertically  into  two  equal 
portions,  we  shall  see  the  whole  extent  of  the  fourth  ventri- 
cle, and  also  the  appearance  in  the  cerebellum  which  is  cal- 
led Arbor  Vitce.  But  before  making  this  section,  there  are 
two  parts  of  the  cerebellum  to  attend  to  ;  the  names  are  ve- 
ry absurd,  but,  since  they  are  always  mentioned,  we  must  de- 
scribe them.  Processus  Venniformis  Superior,  is  the  name 
sjiven  to  the  little  eminence  on  the  highest  portion  of  the  cer- 
ebellujn,  as  it  has  some  resemblance  to  a  worm  coiled  up  ; — 
this  is  the  same  part  which  we  were  obliged  to  hold  aside,  or 
.out  away,  in  showing  the  nates  and  testes,  and  valvula  cere- 
bri. When  we  look  at  the  lateral  parts  of  the  base  of  the 
cerebellum,  upon  the  side  of  the  sulcus  which  corresponds  to 
the  falx  cerebelli,  (and  which  has  been  removed  in  cutting 
the  occipital  bone,)  two  little  convolutions  will  be  seen, 
which,  from  some  faint  resemblance  they  have  to  worms, 
have  been  called  the  Inferior  Vermiform  Processes. 

The  method  just  pointed  out,  is  the  best  manner  of  giving 
an  accurate  notion  of  the  relation  of  the  fourth  ventricle  to 
tire  other  parts, of  the  brain  ;  but  if  we  object  to  it,  in  conse- 
quence of  the  scull  being  hurt  by  cutting  out  the  portion  of 


170 

the  occipital  bone,  we  must  raise  the  base  of  the  brain  from 
the  scoff,  before  we  can  examine  the  parts  in  the  fourth  ven- 
tricle. But  in  doing  this,  there  are  several  points  of  anato- 
my which  should  be  noticed,  previous  to  the  examination  of 
the  ventricle. 

The  scull  should  be  allowed  to  fall  back  a  little,  and  then, 
with  the  handle  of  the  knife,  we  should  lift  part  of  the  ante- 
rior lobe  from  its  position  on  the  frontal  bone.  In  doing  so, 
in  a  very  fresh  brain,  we  may  see  the  Olfactory  Nerves  (I.) 
passing  into  the  cribriform  plate  of  the  ethmoid  bone  ;  but 
this  nerve  is  so  soft,  that,  in  general,  it  is  destroyed  before 
we  reach  this  stage  of  the  dissection.  In  turning  the  lobes 
farther  back,  the  Opiic  Nerves  (II.)  with  the  Carotid  drtciy 
rising  by  the  side  of  J^hem,  will  be  distinctly  seen.  These 
nerves  should  be  eut  across  at  their  entry  into  the  foramen 
opticum.  The  arteries,  if  injected,  should  be  divided  as  far 
down  as  possible  ;  but  if  they  are  not  injected,  it  isgiot  of 
consequence  where  they  are  cut.  On  cutting  througrr the^e 
parts,  we  should  attend  to  a  little  red  projection  which  passes 
towards  the  sella  turcica  ;  this  is  the  Infnndilwhim,  which  is 
attached  to  the  Pituitary  Gland,  The  next  nerve  theJWotor 
O0w&V(Iiy  will  be  easily  discovered  ;  but  the  Trochlearis 
(IV.)  is  difficult  to  find  ;  for  it  is  not  only  very  small,  but  it 
lies  within  the  fold  of  the  dura  mater  which  passes  from  the 
tentorrum  to  the  sphenoid  bone  ;  when  discovered,  it  should 
be  cut,  not  torn.  The  next  nerve,  the  Trigeminus,  (V.)  will 
be  easily  seen,  as  it  is  very  large,  and  goes  off  in  a  lateral  di- 
rection. The  Mducens  (VI.)  will  be  seen  to  run  in  the  same 
direction  as  (III.)  (It  generally  happens,  at  this  stage  of  the 
dissection,  that  the  brain  has  fallen  so  far  back  that  it  must 
be  supported,  or  the  weight  of  the  anterior  part  may  tear  it 
through.)  After  observing  the  (VII.)  which  is  divided  into 
two  parts,  Portio  J^lollis  and  Portio  Dura^  if  we  look  jrtown 
towards  the  foramen  magnum,  we  shall  see  the  scattered  fi- 
bres coming  up  to  form  the  (VIIL)  which  is  composed  of 
three  nerves,  viz.  Glosso  Pharyngeal,  Par  Vagvm,  and  Spj- 
nal  Accessory.  In  cutting  them  across,  we  must  endeavor  to 
leave  the  last  nerve  entire,  as  it  comes  up  from  within  the 
spinal  canal,  to  unite  with  the  other.  The  fibres  forming 
the  Lingualis  (IX.)  will  be  easily  seen. 

The  brain  will  now  be  held  in  its  place,  only  by  the  spina) 
marrow  and  the  vertebral  arteries  ;  the  latter  are  to  be 
snipped  across,  and  then  the  spinal  marrow  is  to  be  cut- 
through,  as  low  down  as  we  can  carry  the  knife. 

We  should  now  lay  the  brain  on  a  wet  board,  and  make 
<inr  observations  on  its  base.  The  f  rst  thing  we  shall  no- 
tice, is  its  division  into  lobes,  which  were  not  obef  rvafele  on 


171 

the  upper  part  :  the  Anterior  and  Middle  lobes  being  sepa- 
rated from  each  other  by  a  sulcus,  called  the  Fissura  Sylvii. 
As  the  Postvrhr  Lobe  has  been  already  destroyed,  we  shall, 
on  the  back  part,  see  only  the  cerebellum.  This  is  divided 
into  two  portions,  which  are  called  its  Lobe* or  Hemispheres. 
We  may  now  observe  how  much  thicker  the  arachnoid  mem- 
brane is  here  than  it  was  on  the  upper  part. 

The-  arachnoid  and  pia  mater  should  now  be  dissected  off, 
and  then  we  shall  see  the  two  Crura  of  the  cerebrum  and  the 
two  of  the  cerebellum  uniting,  to  form  the  P&ns  Varolii,  or 
Tuber  JLnnulare,  or  (a  better  name  still)  the  Nodus  Cerebri, 
which  is  the  commencement  of  the  Medulla  Oblongata,  or 
spinal  marrow.  Immediately  below  the  middle  of  the  nodus 
oerebri,  two  pyramidal  elevations,  called  Corpora  Pyrami* 
da'ra, — and  upon  the  lateral  parts,  two  oval  eminences,  which 
are  called  the  Corpora  OUntria,  will  be  seen.  Between  the 
Corpora  pyramidalia  and  the  nodus,  there  is  a  little  sulcus, 
whicjj^s  called  Foramen  Caecum.  If  we  look  on  the  brain, 
anterior  to  the  nodas,  we  shall  see  two  little  white  bodies, 
the  Corpora ;  Atbirantia  or  Candirantia  :  these,  by  further  in- 
vestigation, will  be  found  to  be  connected  with  the  anterior 
part  of  the  fornix.  Immediately  anterior  to  these,  there  is  a 
reddish  orey  body  (the  infundihulum  ) ;  but  it  will  not  be 
found  hollow,  as  its  name  would  apply.  Between  this  and 
the  optic  nerves,  a  small  square  portion  of  grey  substance 
may  be  observed,  which  will  be  found  to-  be  the  anterior  part 
of  the  floor  of  the  third  ventricle  ;  the  remainder  of  the  floor 
is  made  by  the  corpora  albicantia  and  a  portion  of  medullary 
matter  which  is  between  the  crura  eerebri. 

If  we  now  separate  the  upper  part  of  the  spinal  marrow 
from  its  connection  with  the  cerebellum,  we  shall  see  the  ca- 
vity of  tho  fourth  ventricle  ;  and  by  then  making1  a  vertical  sec- 
tion of  the  cerebellum,  we  shall  have  a  distinct  view  of  the 
arbor  vitse,  and  of  the  sulcus  called  calamus  scriptorius,  which 
in  foetuses,  and  in  some  animals,  is  continued  down,  as  a  ca- 
nal, through  the  substance  of  the  spinal  marrow.  Upon  the 
lateral  parts  of  the  fourth  ventricle,  we  shall  see  little  striae, 
which  are  said  to  be  the  origins  of  the  portio  mollis. 

It  does  not  require  any  particular  rules  to  enable  the  dis- 
sector to  trace  tho  nine  nerves  to  the  parts  of  the  brain  from 
which  they  are  said  to  arise ;  the  filaments  require  only  to  be 
followed. 

The  bulbous  part  of  the  Olfactory  Nerve  will  still  be  visi- 
ble, lying  on  the  anterior  lobe  :  and  upon  tracing  it  back,  it 
will  be  found  to  arise,  by  two  or  three  filaments,  near  the  fis- 
sura  Sylvii ;  these  roots  may  be  generally  traced  to  the  cor- 
pus striatum.  In  tracing  each  of  the  Optic  Nerves  back  from 
their  union,  we  shall  see  a  flattened  baud3  called  Tract  us  G^ 


172 

ticus  turning  round  the  crus  cerebri,  to  take  its  origin  from 
the  thalamus  opticus.  The  Motor  O<nli  requires  no  dissec- 
tion ;  it  is  seen  to  arise  from  between  the  cms  cerebri,  and  no- 
dus cerebri.  The  Trochleari*  is  so  small,  that  we  frequently 
destroy  it  in  removing  the  brain  from  the  scull.  When  pre- 
served, it  may  be  traced,  past  the  crura  cerebri  and  cerebel- 
li, to  arise  from  the  lateral  parts  of  the  fourth  Ventricle.  The 
Trigeminus  cannot  be  mistaken,  as  it  is  the  only  nerve,  arising 
at  the  point  of  union  between  the  crus  cerebri  and  cerebelli. 
The  Abducem  is  also  easily  understood,  for  it  arises  from 
the  point  of  union  between  the  nodus  cerebri  and  the  spinal 
marrow.  We  may  see  a  number  of  small  vessels  entering 
into  the  substance  of  the  brain  here,. which,  when  pulled  out, 
show  why  the  French  anatomists  have  described  this  nerve 
as  arising  from  the  pars  perforce.  The  seventh  is  divided, 
by  a  small  vessel,  into  two  portions  ;  the  one  (Portio  Dura) 
arises  from  the  posterior  and  lateral  parts  of  the  nodus  cere- 
bri ;  the  Portio  Mollis,  deeper, — probably  from  the  anterior 
part  of  the  fourth  ventricle. 

It  is  difficult  to  follow  the  eighth,  as  it  arises  by  several 
distinct  filaments,  but  all  of  which  may  be  traced  from  the 
posterior  column  of  the  spinal  marrow.  The  first  set,  form- 
ing the  filament  called  Glosso  Pharyngeal,  arise  from  the 
edge  of  the  corpus  olivare:  the  next,  the  Nervus  Vagus,  a 
little  lower  down  ;  but  the  third  set  of  fibrils,  forming  the 
Spinal  Accessory  of  the  older  authors,  or  the  superior  exter- 
nal respiratory  of  Mr.  Bell,  must  be  looked  for  in  the  dissec- 
tion of  the  spinal  marrow,  as  they  arise  as  far  down  as  the 
fourth  cervical  vertebra.  The  next  nerve,  the  Lingualis^ 
which  is  the  last  of  the  proper  cerebral  nerves,  is  seen  ari- 
sing by  several  filaments,  from  the  edge  of  the  corpus  pyra.- 
midale. 

If  we  examine  the  nodus  cerebri  minutely,  we  shall  find 
that  the  crura  cerebelli  unite,  and  the  erura  cerebri  pass  un- 
der them  ;  whence  the  part  was  called,  by  Varolius,  Pons* 
Upon  the  surface  of  the  pons  we  see  a  furrow,  which  is  cal- 
led the  Raphe.  If  we  cut  the  pons  horizontally,  so  as  to  cut 
also  the  crura  cerebri,  we  shall  show  the  mixture  of  cineri- 
tious  and  medullary  matter,  which  has  been  called  the  Lo* 
cm  Niger;  and  in  the  section  of  the  crura  cerebelli,  we  shall 
fiad  a  stain  of  yellowish  matter,  which  is  called  Corpus  Rhom- 
boideum,  or  dentatum.  In  this  view  we  shall  also  see  the 
medullary  tracts  which  pass  down  towards  the  corpora  pyra- 
midalia,  and  the  transverse  fibres  which  run  at  right  angles 
to  them.  By  separating  the  two  corpora  pyramidalia  from 
each  other,  we  may  see  bands  running  from  one  side  to  the 
other,  so  that  here  the  bodies  appear  to  decussate.  In  the 


173 

section  of  the  corpus  olivare,  a  regular  oval  medullary  sub- 
stance is  seen,  surrounded  by  cineritious  matter,  and  which 
is  called  Corpus  Dcntatum  Eminent.?  &  Olivaris  ;  small  cords 
also  project  from  the  back  part  of  the  corpora  olivara,  which 
have  received  the  name  of  Corpora  Restiformia. 

Having- finished  this  part  of  the  dissection,  we  may  look  to 
the  sinuses.  In  the  first  stage  of  the  dissection,  the  Lontri- 
tuidinal  Smus  was  traced  to  its  division  into  the  two  Lateral 
Sinuses.  In  dissecting-  the  velum  interpositum,  the  vein  cal- 
led vena  Galeni  was  seen  carrying-  its  blood  to  a  sinus,  in  the 
middle  of  the  tentorium,  which  is  called  the  Fourth  Sinus; 
this  runs  to  the  point  of  union  between  the  longituidinal  and 
two  lateral  sinuses — the  union  forming  the  Torcular  Hier- 
ophiti.  On  the  lower  edge  of  the  falx,  a  very  small  sinus 
may  be  discovered,  which  is  generally  called  the  Inferior 
Longituidinal  or  Fifth  Sinus.  By  pouring  a  solution  of  cor- 
rosive sublimate  in  muriatic  acid,  diluted  with  a  large  quan- 
tity of  water,  upon  the  base  of  the  scull,  the  blood  in  the  les- 
ser sinuses  will  be  coagulated,  so  as  to  make  them  apparent. 
This  solution  will,  at  the  same  time,  make  the  nerves  appear 
more  distinct. 

The  sinuses  in  the  base  of  the  scull  are  generally  named 
according  to  the  parts  on  which  they  are  situated,  with  the 
exception  of  the  Cavernous  Sinus  said  Circular  Sinus;  the 
first  of  which  is  on  the  lateral  part  of  the  sella  turcica  ;  the 
other  surrounds  it.  All  the  rest  are  included  under  the  names 
of  Sphenoidal,  Petrous  and  Occipital ;  their  particular  ap- 
pellations being  given  according  to  the  parts  of  those  bones 
©n  which  they  are  situated. 

As  it  will  be  necessary  to  destroy  the  muscles  of  the  back 
before  we  can  examine  the  spinal  marrow,  it  ought  not  to  be 
done  at  present,  though  the  description  of  the  manner  of  do* 
ing  it,  is  introduced  here. 

The  easiest  way  of  opening  the  spinal  canal,  is  to  cut 
through  the  roots  of  the  spinous  processes  w^4i  a  saw,  or,  still 
better,  with  a  large  knife  (a  plumber's  hacking  knife)  and  a 
mallet,  and  then  to  tear  up  the  processes  with  a  pair  of  pin- 
cers. This  will  expose  the  sheath  of  the  spinal  marrow, 
which  is  a  continuation  ofthe  dura  mater.  On  opening  the 
sheath,  we  shall  see  the  medullary  cord,  surrounded  by  its 
proper  coats,  the  tunica  arachnoides  and  pia  mater  ;  but  be- 
sides these,  there  will  be  also  a  membranous  connection 
seen  between  the  lateral  part  ofthe  spinal  marrow  and  the 
sheath,  which  is  continued,  by  distinct  and  pointed  slips, 
from  the  suboccipital  nerve  to  the  second  or  third  lumbar 
ti.erve.  This  membrane,  from  ha  vino-  some  .resemblance  to 


174 

the  teeth  of  a  saw,  has  been  called  the  Ligamentum  Dtnti- 
wlatum. 

The  spinal  cord,  at  first  view,  appears  to  be  uniform  ;  but 
when  we  remove  the  membranes,  we  shall  see  a  fissure* 
which,  on  the  posterior  part,  is  continued  from  the  calamus 
scriptorius :  and  on  the  anterior,  from  the  fissure  between 
the  corpora  pyramidalia  ;  by  these,  the  column  is  divided  in- 
to two  lateral  parts,  each  of  which  is  subdivided  into  an  an- 
terior and  posterior  portion.  This  we  can  more  readily  per- 
ceive, by  examining  the  origin  of  one  of  the  spinal  nerves  ; 
for  they  have  each  a  distinct  root  from  the  anterior  and  pos- 
terior portion.  But  to  follow  this  subject  farther,  see  the 
dissection  of  the  Spinal  Nerves* 


MANNER  OF  EXAMINING  THE  BRAIN 

TO  DISCOVER 

THE  APPEARANCES  OF  DISEASE. 


As  I  cannot  go  fully  into  the  description  of  the  morbitf 
anatomy  of  the  brain,  1  shall  only  make  such  remarks,  as  I 
hope  will  induce  the  student  to  investigate  the  subject. 

The  scull  should  be  opened,  nearly  in  the  same  manner  ae 
described  at  page  160* 

In  cutting  through  the  scalp,  we  ought  to  calculate  how 
far  the  degree  of  fulness  of  its  vessels  is  attributable  to  the 
position  of  the  head  after  death ;  and  in  raising  the  scull-cap, 
we  should  recollect,  that  the  degree  of  resistance,  produced 
by  the  adhesion  of  the  dura  mater  to  the  bone,  will  depend 
on  the  age  of  the  subject,  or  on  a  particular  form  of  the  scull ; 
the  quantity  of  blood  which  escapes  in  tearing  up  the  scull, 
will  generally  correspond  with  the  state  of  the  vessels  in  th* 
scalp. 

The  appearances  of  disease  on  the  external  part  of  the  du- 
ra mater,  frequently  depend  on  the  state  of  the  scull.  Thus. 
if  there  has  been  a  puffy  tumour  of  the  scalp,  in  consequence 
of  a  blow,  and  if  the  bone  be  dead,  there  will  probably  be 
matter  on  the  corresponding  part  of  the  dura  matter ;  but  if 
there  has  been  a  venereal  caries  of  the  scull,  which  has  made 
slow  process,  it  is  more  likely  that  several  layers  of 
will  be  found  upon  the  dura  mater* 


175 

If  a  piece  of  bone  has  exfoliated,  or  if  ft  portion  has  been 
removed  by  the  trephine,  the  hole  will  be  found  to  be  filled 
up  by  a  fungous  growth  of  the  dura  mater  ;  but  if,  instead 
of  this,  the  dura  mater  has  ulcerated,  there  will  be  a  protru- 
sion of  the  brain.  As  tumours  are  very  seldom  fotind  on  the 
dura  mater,  unless  there  has  been  also  disease  of  the  bone, 
we  must  be  cautious  in  pronouncing  the  large  clusters  of 
glandulse  Pacchioni,  which  are  occasionally  lodged  in  cor- 
responding fovese  in  the  scull,  to  be  fungous  tumours. 

The  appearances  which  are  said  to  denote  a  previous  slight 
degree  of  inflammation  of  the  dura  mater,  are  very  questiona- 
ble. That  red  appearance,  which  is  generally  described  as 
the  effect  of  inflammation,  may  be  washed  off:  but  after 
phrenitis,  or  violent  injuries  of  the  head,  there  will  be  no  dif- 
ficulty in  determining  whether  there  has  been  inflammation , 
because  the  vessels  on  the  external  surface  of  the  dura  ma- 
ter, will  be  as  much  blood-shot  as  the  vessels  of  the  conjunc- 
tiva are  in  ophthalmia,  and  there  will  be  even  layers  of  lymph 
occasionally  found  on  its  inner  surface.  In  such  cases,  the 
other  membranes  will  be  also  inflamed. 

It  is  not  uncommon,  to  find  deposits  of  bone  in  different 
parts  of  the  dura  mater,  but  particularly  in  the  falx.  In 
three  cases,  in  which  these  deposits  were  found  in  contact 
with  the  olfactory  nerve,  the  patients  had  been,  for  a  consid- 
erable time  previous  to  death,  very  uncomfortable,  from  the 
sensation  of  unpleasant  odours. 

In  cases  of  apoplexy,  or  very  severe  injuries  of  the  head, 
we  shall  occasionally  find  a  quantity  of  blood  under  the  dura 
mater.  It  is  highly  important  to  observe  the  manner  in  which 
the  blood  is  spread  over  the  surface  of  the  brain  ;  as  it  will 
show  the  inutility  of  puncturing  the  dura  mater  after  trepan, 
with  the  intention  of  evacuating  blood  which  may  be  under  it 

We  should  particularly  recollect  that  there  is  a  natural  ad- 
hesion between  the  dura  mater  and  the  other  membranes  in 
the  line  of  the  longitudinal  sinus,  and  that  it  always  has  a; 
pocky,  granulated  appearance,  because  this  has,  by  many, 
been  ascribed  to  the  effect  of  disease. 

TUNICA  ARACHNOIDES. — This  will  be  found  thickened  in 
all  cases  where  inflammation  of  the  brain  has  existed  for 
some  time,  and  then  there  will  also  generally  be  effusion 
of  serum  under  the  membrane.  It  is,  perhaps,  improper  ta 
attach  much  importance  to  this  effusion,  because  it  is  found 
in  almost  every  case  of  protracted  disease, — as  in  fever,  or 
in  cases  where  a  patient  has  died  in  consequence  of  irrita- 
tjLon  of  any  viscus,  and  particularly  after  any  operation  ou 
the  bladder,  or  from  retention  cfurjm*.  When  we  find  this 


176 

effusion,  we  may  predict  that  there  will  be  water  in  the  ven- 
tricles. 

PIA  MATER. — The  gorged  state  in  which  the  vessels  of 
the  pia  mater  are  frequently  found,  in  consequence  of  the 
position  of  the  head  after  death,  is  often  called  inflammation ; 
but  in  the  true  inflammation,  the  vessels  of  the  pia  mater  will 
be  very  numerous,  and  the  membrane  will  be  found  thicken- 
ed. 

SUBSTANCE  OF  THE  BRAIN. — In  the  infant  it  is  very  soft ; 
it  gradually  becomes  firmer  until  extreme  old  age,  and  then  it 
is  found  occasionally  softened ;  though  at  the  age  of  ninety- 
seven,  I  have  seen  it  as  firm  as  that  of  a  middle  aged  person. 

It  is  very  difficult  to  determine  whether  the  great  fulness 
of  the  vessels  is  to  be  taken  as  denoting  that  there  has  been 
any  particular  action  in  them  during  the  life  of  the  patient; 
because  there  is  frequently  an  unnatural  degree  of  fullness  to 
be  found  in  the  vessels  of  the  brain  of  persons  in  whom  there 
were  no  symptoms  of  deranged  functions  during  life.  I  am, 
therefore,  inclined  to  consider  the  fullness  of  the  vessels,  in 
the  greater  number  of  cases,  to  be  in  a  great  measure  depen- 
dant on  the  position  of  the  head  after  death,  and  particularly 
in  those  cases  of  fever,  whore,  in  consequence  of  the  blood 
not  coagulating,  it  flows  freely  up  by  the  deep  veins,  in  which 
the  valves  are  generally  so  imperfect,  as  to  permit  the  blood 
to  pass.  We  may  often  see  a  proof  of  this,  in  the  quantity  of 
blood  which  escapes  after  the  brain  is  removed,  if  the  head 
be  left  in  a  depending  position. 

The  air  which  is  frequently  seen  in  the  vessels,  is  either 
generated  by  putrefaction,  or  rushes  in  when  the  scull  is 
torn  up. 

The  substance  of  the  brain  is  generally  very  tough  and 
firm  in  those  who  have  suffered  from  mania  ;  and  in  these  ca- 
ses, the  convolutions  on  the  surface  are  also  very  distinct. 

After  epilepsy,  we  may  expect  to  find  solid  tubercles  in  the 
substance  ;  but  I  have  generally  found  them  near  the  base 
of  the  brain. 

If  the  scull  has  been  diseased,  the  inflammation  may  be 
propagated  to  the  substance  of  the  brain,  and  abscess  may 
be  found  in  it.  In  such  a  case,  the  disease  can  be  traced 
from  the  external  to  the  internal  parts  ;  but  in  a  case  of  ab- 
scess without  disease  of  the  bone,  we  may  suspect  that  we 
are  coming  upon  a  diseased  portion,  when  we  find  a  part  of 
the  substance  of  the  brain — green,  and  of  a  mottled  colour. 

The  fungus,  or  hernia  cerebri,  in  consequence  of  fracture 
of  the  scull  and  laceration  of  the  dura  mater^  will  be  found 
to  be  formed  by  a  protrusion  of  a  part  of  the  brain,  on  the* 
surface  of  which  there  are  several  layers  of  lymph>  thai 


177 

give  it  the  appearance  ef  fungus.  But  if  the  tumor  arise  af- 
ter exfoliation  of  the  bone  and  sloughing1  of  the  dura  mater, 
there  will  probably  be  a  greater  proportion  of  lymph  on  the 
surface  ;  which  has  led  some  to  doubt  the  fact  of  there  ever 
being  a  protrusion  of  the  substance  of  the  brain  itself.  In 
this  latter  case,  an  abscess  will  generally  be  found,  extend- 
ing from  the  fungus  to  the  ventricle. 

When  a  patient  dies  in  a  fit  of  apoplexy,  we  shall  sometimes 
find  only  a  very  small  clot,  but  occasionally,  a  mass  of  firm  blood 
weighing  some  ounces.  Where  there  is  a  large  coagulum, 
the  substance  of  the  brain  will  be  firm,  and  its  vessels  empty. 
In  the  greater  number  of  these  apoplectic  cases,  it  is  very 
difficult  to  discover  the  source  of  the  bleeding ;  and  it  is, 
with  much  reason,  supposed  to  be  frequently  from  very  small 
vessels ;  but  if  the  patient  has  been  suddenly  seized  while 
drunk,  and  struggling,  there  will  probably  be  rupture  of  a 
large  vessel.  If  a  patient  has  survived  an  attack  of  apoplexy, 
we  may  discover  the  cavity  in  which  the  coagulum  lay,— - 
The  sides  of  it  will  be  smooth  and  tough ;  and  there  will  be 
serum,  in  place  of  the  ceaguluia,  which  has  beer,  absorbed. 

If  a  man  has  been  suddenly  killed,  while  in  a  state  of 
health,  the  ventricles  will,  on  examination,  be  found  to  be 
merely  lubricated  with  a  fluid  ;  but  in  all  cases  where  pa- 
tients die  of  protracted  disease,  more  or  less  water  will  be 
found  in  the  ventricles.  In  the  acute  hydrocephalus,  there  is 
frequently  several  ounces :  but  in  the  chronic  hydrocephalus, 
the  quantity  of  water  will  correspond  to  the  size  of  the 
head, — as  in  this  disease,  the  iftass  of  the  brain  forms  a  mere 
sac  for  the  water. 

The  state  of  the  plexus  choroides  should  be  compared  with 
the  appearance  of  the  pia  mater,  for  it  will  generally  corres- 
pond with  it. 

Small  cysts,  like  hydatids,  are  so  frequently  found  attached 
to  the  plexus  choroides,  that  we  can  hardly  consider  them  to 
be  of  importance  ;  but  there  are  a  few  examples  on  record  of 
very  large  cysts,  or  hydatids,  having  been  found  in  the  sub- 
stance of  the  brain.  In  the  Museum,  in  Great  Windmill 
Street,  there  are  two  very  fine  specimens;  one  of  them  con- 
tained four  ounces  of  fluid. 

The  Pineal  gland  is  sometimes  very  soft  ;  at  other  times 
it  appears  like  a  vesicle.  I  have  so  frequently  found  it  in 
£oth  of  these  states,  that  I  cannot  attach  more  importance 
to  them,  than  to  the  gritty  matter  which  is  so  often  found  in 
it. 

So  far,  the  examination  should  be  conducted  nearly  in  the 
same  manner  as  that  described  for  investigating  the  natural 
anatomy ;  but  to  prosecute  it  farther,  the  braiu  should  be 


178 

raised  from  the  base  of  the  scull. — I  shall  endeavour  to  make 
my  remarks  correspond  with  the  order  in  which  the  parts 
will  be  presented  when  the  brain  is  raised  from  the  anterior, 
and  carried  towards  the  posterior  part. — I  shall,  therefore, 
first  observe,  that  if  there  has  been  disease  of  the  ethmoid 
bone, — as  from  polypus  of  the  nose,  venereal  caries,  &c.  we 
may  expect  to  find  a  corresponding  state  of  the  anterior  lobes 
of  the  brain. 

It  may  be  laid  down  as  a  general  rule,  that  the  carotid  and 
vertebral  arteries  are  always  more  or  less  ossified  in  a  person 
above  the  age  of  fifty. 

If  a  person  has  been  blind  of  one  eye,  we  should  examine 
the  corresponding  optic  nerve,  which  will  probably  be  small 
and  transparent,  and  endeavour  to  trace  it  to  the  thalami,  so 
as  to  assist  in  deciding  whether  the  nerves  always  decus- 
sate (for  it  is  still  a  question  ;)  though  I  may  here  observe, 
that  when  the  left  eye  was  blind,  I  have  always  found  the 
right  troctus  opticus  much  smaller  and  more  transparent  than 
the  other ;  and  vice  versa. 

If  there  be  matter  in  the  cerebellum,  we  should  look  to 
The  state  of  the  temporal  bone;  for  scrophulous  caries  in  this 
bone  will  often  be  the  cause  of  disease  in  the  brain. 

When  there  is  water  found  lodging  upon  the  scull  after 
the  brain  is  removed,  we  must  not  suppose  that  it  has  existed 
there  during  the  life  of  the  patient,  but  that  it  has  escaped 
from  the  several  cavities  during  the  dissection,  and  has  fallen 
down  to  this  part. — It  may  even  fall  into  the  sheath  of  the 
spinal  marrow  ;  but  it  must  be,  at  the  same  time,  admitted, 
that  when  there  is  water  in  the  ventricles  of  the  brain,  there 
will  be  generally  some  found  between  the  spinal  marrow 
and  its  membranes,  and  perhaps  even  without  disease,  for  in 
the  prosecution  of  experiments  on  the  spinal  marrow  of  the 
ass,  I  have  had  occasion  to  open  the  sheath  several  times  be- 
tween the  occiput  and  atlas;  and  in  every  instance,  imme- 
diately on  puncturing  it,  about  two  ounces  of  clear  limpid 
fluid  have  escaped  in  a  stream.  This  I  have  noticed,  in  a 
proportionate  degree,  in  other  animals. 

In  consequence  of  the  difficulty  in  opening  the  spinal  ca- 
nal, we  are  frequently  unable  to  ascertain  positively,  whether 
the  parts  within,  are  diseased  or  not.  Of  late  years,  it  has 
been  a  common  opinion,  that  the  spinal  marrow  is  violently 
inflamed  in  cases  of  tetanus ;  but  I  suspect  that  in  the  greater 
number  of  the  cases  which  have  been  related,  that  the  ap- 
pearance produced  by  the  gravitation  of  the  blood  after 
death,  has  been  mistaken  for  inflammation :  and  this  I  have 
been  more  convinced  of,  since  I  lately,  with  a  view  to  ascer- 
tain the  truth  of  this,  examined  the  tody  of  a  man  who  haU 


179 

died  of  tetanus.  Immediately  on  the  death  of  the  patient,  T 
got  the  body  laid  upon  the  belly,  instead  of  the  common  po- 
sition :  upon  opening-  the  spine,  there  was  no  appearance  of 
that  loaded  state  of  the  vessels  on  the  posterior  column, 
which  has  been  considered  as  a  proof  of  the  previous  exis- 
tence of  inflammation  of  the  spinal  marrow ;  but  the  ante- 
rior  portion,  which,  in  this  case,  had  been  the  most  depend- 
ing1 part  while  the  blood  was  gravitating-,  was  covered  with 
a  congeries  of  distended  vessels.  I  may  here  also  observe, 
that  if,  in  opening  the  spine,  we  puncture  the  membranes  of 
the. spinal  marrow,  that  part  of  the  nervous  pulp  will  be  for- 
ced out  in  the  form  of  a  tumour.  This  will  perhaps  account 
for  many  of  the  tumours  which  are  discovered  in  the  spinal 
marrow.  But  it  is  not  my  intention  to  deny  either  the  occa- 
sional inflammation  of  the  spinal  marrow,  or  the  existence 
of  tumours  in  it ;  for  I  have  several  times  seen  tumours,  of 
firm  consistence,  in  it,  arid  similar  to  those  which  are  occa- 
sionally found  in  the  brain.  I  have  also,  in  many  instances, 
seen  the  membranes  highly  inflamed, — and  even  matter  on 
their  surface,  which  has  extended  down  to  the  cauda  equine. 

INVESTIGATION  OF  THE  STATE  OF  THE  HEAD' 
IN  CASES  OF  SUDDEN  DEATH. 

When  called  upon  to  investigate  the  state  of  the  head  in 
cases  of  sudden  death,  or  of  death  from  injury,  we  must  be 
particularly  guarded  in  giving  an  opinion  :  for  it  is  exceed- 
ingly difficult  to  ascertain,  whether  many  of  the  appearances 
are  attributable  to  injury,  or  to  previous  disease,  or  to  a 
change  which  has  taken  place  after  death.  Of  the  difficulty 
of  coming  to  a  decision  on  this  subject,  I  am  the  more  con- 
vinced, the  greater  number  of  bodies  I  examine.  But  as  I 
cannot  enter  into  the  question  fully,  I  shall  only  give  a  few 
hints ;  which,  however,  1  hope  will  induce  the  student  to  in- 
vestigate the  subject  further. 

The  first  thing  we  should  know,  is,  that  there  is,  very  fre- 
quently, an  appearance  of  bruises  on  the  scalp;  which,  how- 
ever, is  only  the  effect  of  pressure  on  a  particular  part  of 
the  head,  when  the  scalp  is  cedematous  and  loaded  with 
Wood. 

The  question  whether  there  has  been  a  fracture  previous 
to  death,  is  sometimes  more  difficult  to  decide,  than  a  per- 
son, who  is  not  accustomed  to  dissection,  could  imagine.  If 
the  fracture  has  occurred  immediately  before  the  patient's 
death,  there  will  be  coagulated  blood  found  upon  the  bone, 
and  in  the  fissures ;  but  if  the  patient  hat?  survived  foj-  some 


180 

time,  there  will  be  marks  of  inflammation,  and  perhaps  pus 
in  contact  with  the  scull.  If  a  fracture  has  been  produced 
in  making  the  examination,  (which  sometimes  happens  even 
in  a  very  careful  dissector's  hands,)  the  blood  in  the  fracture 
Will  not  be  coagulated,  nor  will  there  be  any  effusion  around 
the  portions.  If  there  have  been  symptoms  of  fracture  after 
a  blow  on  the  upper  part,  and.  if  we  cannot  discover  one  op- 
posite to  the  part  struck,  we  should  look  to  the  temples,  or  to 
the  base  of  the  scull. 

It  has  been  already  remarked,  that  a  blow  on  the  scalp 
may  be  followed  by  abscess  in  the  brain ;  but  we  ought  to  re- 
collect, that  a  blow,  which,  in  a  greater  number  of  constitu- 
tions, would  be  a  mere  trifle,  may,  in  certain  habits,  be  at- 
tended by  a  train  of  symptoms  which  may  cause  death. 

If  effusion  of  blood  be  found  between  the  dura  mater  and 
scull,  and  if  a  bruise  on  the  scalp  corresponds  to  the  part, — 
we  may  conclude,  that  it  has  been  caused  by  the  blow ;  but 
if  blood  is  found  between  the  dura  mater  and  the  brain, 
though  we  should  discover  the  marks  of  blows,  or  even  frac- 
ture of  the  scull,  still  the  question  may  be, — might  not  the 
patient  have  been  attacked  with  apoplexy  during  a  struggle  ? 
'An  interesting  question  of  this  kind  occurred  at  the  York 
Assizes,  in  the  summer  of  1820. — But  I  shall  here  introduce 
the  history  of  a  case  which  occurred  about  twelve  years  ago, 
and  at  the  dissection  of  which  I  assisted.  This  case  has 
always  made  a  great  impression  on  my  mind,  for,  as  I  was 
then  very  young,  I  might  have  given  a  very  erroneous  opin- 
ion upon  it. 

It  is  related  in  Dr.  Cheyne's  Treatise  on  Apoplexy. 

"  An  industrious  man  returning  home  from  hi?  work,  found 
riis  house  empty  of  every  thing, — the  bed  he  was  to  lie  upon, 
and  the  tools  of  his  trade,  sold  for  gin  by  his  wife,  whom  he 
found  in  a  gin  shop,  where  she  had  been  drinking  and  dan- 
cing. He  brought  her  home,  and  in  the  passage  of  his  house 
struck  her,  and  ordered  her  to  go  up  stairs.  She  refused  ta 
go ;  he  carried  her  upon  his  shoulders,  and  the  contention 
continuing  up  stairs,  he  struck  her  again.  There  having 
been  no  one  present,  we  have  only  the  husband's  account  of 
her  death.  He  said,  that  whilst  sitting  on  her  chair,  she  fell 
down,  upon  which  he  threw  her  on  the  bed,  conceiving  she 
was  in  a  fit,  such  as  he  had  seen  her  in  formerly.  Some  of 
her  neighbors  coming  in,  found  her  dead.  Mr.  C.  Bell  was 
Tequested  to  examine  the  body  of  this  woman.  The  man 
Was  afterwards  tried  at  the  Old  Bailey  for  murder,  and  Mr. 
Bell's  deposition  was  nearly  to  this  effect.  In  the  abdometx 
and' thorax,  nothing  appeared  remarkable,  further  than  thai 
the  stomach  contained  a  quantity  of  gin  ;  and  that  then*  was 


181 

a  blush  of  redness  on  the  lower  orifice  of  the  stomach  and 
duodenum.  On  the  head,  there  were  several  bruises  ;  but 
the  bone  was  not  at  all  hurt,  and  no  extravasation  appeared 
under  the  bone.  On  exposing-  the  membranes  of  the  brain, 
the  vessels  of  the  pia  mater  were  empty  of  blood,  as  if  from 
pressure.  There  was  a  serous  effusion  under  the  tunica 
arachnoidea,  and  in  the  cavities  of  the  brain,  similar  to  what 
has  been  found  in  those  who  have  died  from  intoxication. 
On  the  surface  of  the  brain,  there  were  what  appeared  to  be 
spots  of  extravasated  blood  ;  but  upon  tracing-  them  towards 
the  base,  they  proved  to  be  streams  of  blood  which  had  flow- 
ed from  a  vessel  ruptured  in  the  base  of  the  brain.  The  base 
of  the  brain  was  covered  with  coagulated  blood,  in  which  al- 
so, all  the  roots  of  the  nerves  were  involved.  On  dissetting 
the  cavities  of  the  brain,  the  blood  was  found  to  have  pene- 
trated into  the  third  ventricle,  by  perforating-  its  floor.  Upon 
taking  out  the  brain,  and  tracing  the  vessels  in  the  base,  the 
anterior  artery  of  the  cerebrum  going  off  from  the  internal 
carotids  of  the  left  side,  was  found  torn  half  way  across  : 
from  this  source  came  the  extravasated  blood. 

k<  The  cause  oftiiis  woman's  death  was  the  bursting1  of  the 
blood  from  the  ruptured  vessel,  and  the  pressure  on  the  brain, 
or,  more  correctly  speaking,  on  the  vessels  of  the  brain.  A? 
to  the  cause  of  the  rupture,  Mr.  Bell's  opinion  coincided  with 
the  best  authorities  in  pathology,  that  there  is  a  state  of  the 
vessels  in  which  an  external  injury  or  shock  is  more  apt  to 
produce  rupture, — and  drunkenness  may  be  supposed  to  be 
tiie  artificial  state  of  excitement,  which  most  resembles  this 
state  of  the  vessels.  Being  asked  whether  the  blows  were 
the  cause  of  the  rupture  ?  he  said  he  conceived  it  very  likel y 
that  a  shock  would  rupture  the  vessel :  and  being  then  asked 
whether  he  conceived  that  this  woman  was  more  likely  to 
have  a  vessel  ruptured  from  having  been  intoxicated  ?  he 
was  of  opinion,  that  intoxication,  and  the  struggle,  were  like- 
ly  to  produce  such  a  degree  of  activity  of  the  circulation  in 
Uie  head,  that  a  less  violent  blow  might  produce  rupture  than 
what,  in  other  circumstances,  would  have  proved  fatal." 

The  man  was  acquitted. 


182 

DISSECTION 

OF 

THE  MUSCLES 

ON  THE 

FORE  PART  OF  THE  NECK. 


Ptaiysma  Nyoides  is  the  first  muscle  to  be  disserted. 
The  fibres  of  this  muscle  are  frequently  so  thin  and  indi.-tinrt 
that  a  student  will  find  it  sometimes  difficult  to  expose  them, 
particularly  as  they  have  neither  origin  nor  insertion  in  bon?. 

A  block  of  wood  should  be  put  under  the  shoulders,  arid 
the  head  should  be  fixed  by  a  chain  hook  to  the  table,  .so  as  to 
make  the  fibres  of  the  superficial  layer  of  the  muscles  tense.* 
An  incision  should  then  be  made  through  the  skin  o?/fy,  iron] 
midway  between  the  chin  and  the  ear,  to  about  three  fingers' 
breadth  from  the  sternal  end  of  the  clavicle.  This  incit  ion 
will  expose  the  fibres  of  the  platysma,  about  their  middle. 
The  dissection  should  be  continued,  by  cutting  in  the  same 
line,  first  towards  the  larynx,  and  then  towards  the  back  part 
of  the  neck.  In  dissecting  towards  the  fore  part,  the  fibres 
of  the  sterno  hyoideus  will  probably  be  in  part  exposed  ;  and 
towards  the  back  part,  the  fibres  of  the  sterno  cloido  mat-toi- 
dens  will  appear  under  the  fascia,  or  condensed  cellular  mem- 
brane, in  which  the  fibres  ot  the  platysma  terminate. 

The  platysma  may  be  cut  across.,  about  its-  middle.  The 
lower  half  is  then  to  be  carried  toward*?  the  chest,  by  which 
we  shall  expose  the  fibres  of  the  sterno  cleido  mastoiueus  ; 
but  in  doing  this,  we  should  begin  at  the  inner  angle  of  the 
flap,  and  dissect  in  an  oblique  direction,  or  we  shall  be  ob- 
liged to  cut  in  a  line  across  the  fibres  of  the  tsterno  cleido 
rnastoideus  muscle,  which  will  increase  the  difficulty  of  rais- 
ing the  cellular  membrane.  1  he  f-.ame  thing  is  to  be  recol- 
lected in  lifting  the  upper  portion. 

When  the  platysma  is  raised,  we  shall  see  a  number  of 
glands  on  each  side  of  the  bterno  cleido  maetoideus  ,  but  these 
we  may  cut  away  without  paying  particular  attention  to 
them  in  the  present  dissection. 

The  muscles  which  run  from  the  jaw  to  the  oshyoides,  and 
those  from  the  sternum  to  the  game  point,  will  be  now  par- 

*  Previous  to  the  dissection  of  these  muscles,  the  student 
should  particularly  examine -the  os  hyoides,  and  the  external 
cartilages  of  the  larynx. 


183 

tially  exposed : — but  previous  to  dissecting  either  of  these 
sots  of  muscles,  the  origins  and  insertions  of  the  Sterno  Clei- 
do  JWasttoiden*  should  be  shown,  after  which  the  muscle  may 
be  cut  through  about  the  middle ;  one  half  of  it  is  then  to  be 
carried  up  towards  the  occiput,  and  the  other  towards  the 
clavicle. 

There  will  now  be  little  difficulty  in  exposing  the  small 
muscles,  for  the  course  of  the  fibres  of  several  of  them  will  be 
seen  under  a  thin  layer  of  cellular  membrane. 

The  Sterno  Hyoideus ,  which  is  the  most  superficial,  may 
be  shown  in  its  whole  extent.  But  at  present,  we  cannot 
exhibit  the  origin  of  the  next  muscle,  (the  Onio  Hyoideus,)  be- 
cause it  arises  from  the  scapula  ;  but  by  dissecting  towards 
the  shoulder,  we  shall  find  a  central  tendon,  which  divides 
this  muscle  into  two  parts,  whence,  besides  the  common 
name  of  01110  hyoideus,  it  has  been  called  Digastricus, — and 
the  term  Inferior  is  also  added  to  it,  as  there  is  another  dou- 
ble bellied  muscle  situated  under  the  jaw. 

The  muscle  which  will  be  partially  seen  between  the  two 
last,  IB  the  Sternff  Tfvyr&ideiis.  To  expose  it  fully,  the  ster- 
110  hyoidous  should  be  cut  through  the  middle,  or  held  aside. 
In  dissecting1  the  sterno  thyroideus,  the  young  student  is  ve- 
ry apt  to  raise  the  origin  of  the  Thyro  Hyoideus  ^  which  runs 
from  the  thyroid  cartilage  to  the  os  hyoides,  and  thus  to  give 
the  appearance  of  two  sterno  hyoidei  muscles.  When  the 
sterno  thyroid  is  raised,  one  half  of  the  Thyroid  Gland  will 
be  seen  ;  and  if  it  be  pulled  aside,  the  small  muscle  which 
passes  from  the  cricoid  cartilage  to  the  thyroid,  (Crico  Thy- 
roideux,)  may  be  shown. 

The  dissection  of  the  muscles  which  run  from  the  jaw  to 
the  os  hyoides,  should  now  be  made. 

\s  the  most  superficial  mnscie,  the  Biventer  Superior,  is 
composed  of  two  parts,  it  will  be  necessary  to  dissect  in  two 
ijinv.rpiit,  directions,  to  expose  its  fibres.  The  origin  of  the 
portion  which  runs  from  the  mastoid  process  towards  the  os 
hyoide-;-?,  may  be  first  dissected.  To  see  its  origin,  we  must 
raise  the  lobe  of  the  para.ti'1 ;  and  in  showing  the  connection 
of  its  middle  tendon  with  the  os  hyoides,  (which  is  only  by  a. 
ligament,)  we  must  take  care  that  we  do  not  cut  through  the 
fibre*  of  the  stylo  hyoideus,  which  is  perforated  by  it.  The 
maxillary  half  of  the  muscle  is  to  be  dissected  by  carrying  the 
knife  in  a  direction  from  the  chin  to  the  os  hyoides. 

The  next  muscle  to  be  dissected,  is  the  'Jlfylo  Hyoideus, 
But.  before  its  middle  fibres  can  be  seen,  that  part  of  the  sub- 
maxillary  gland  which  lies  upon  it,  must  be  removed  ; — nor 
w.U  its  attachment  to  the  centre  of  the  jaw,' or  its  connection 


184 

with  its  fellow,  be  seen,  until  the  anterior  portion  of  the  bi- 
venter  is  raised. 

If  the  mylo  hyoideus  be  carefully  raised  from  the  jaw,  and 
and  from  its  connection  with  the  mylo  of  the  opposite  side, 
the  Genio  Hyoideus  will  be  seen  running  from  the  jaw  to  the 
os  hyoides  :  but  it  is  so  closely  attached  to  its  fellow,  that  the 
two  muscles  appear  to  form  only  one.  There  is  another  set 
of  fibres  which  take  nearly  the  same  origin  as  the  genio  hy- 
oides ;  but  as  these  fibres  run  both  to  the  os  hyoides  and  to 
the  tongue,  the  muscles  which  they  form  is  called  Genio  Hyn 
Glossut.  Certain  fibres  may  now  be  seen  passing  from  the 
os  hyoides  to  the  tongue,  to  form  the  Hyo  Gtossus, — on  the 
inside  of  which  may  be  found  a  set  of  fibres,  running  from  th»r 
base  to  the  tip  of  the  tongue,  to  form  the  Lingitalis. 

The  next  object  of  the  dissection  should  be,  to  display  the 
lateral  muscles — the  Styloid.  To  do  this,  the  lower  portion 
of  the  parotid  gland  should  be  raised,  and  the  origin  of  the 
digastricus  should  be  cut.  When  this  is  done,  some  of  the 
branches  of  the  carotid  will  be  exposed  :  but  these,  at  pre- 
sent, may  be  cut  through. 

Three  muscles  may  now  be  easily  shown,  running  from 
the  styloid  process  :  — one,  to  the  os  hyoides  ;  another,  to 
the  tongue  ;  and  the  third  to  the  pharynx.  As  each  of  these 
muscles  is  named  according  to  its  origin  and  insertion,  they 
are  called  Stylo  Hyaideus,  Stylo  Glossus,  and  Stylo  Pharyngi- 
tis. The  dissection  of  them  will  be  facilitated  by  pulling  the 
os  hyoides  downwards,  and  towards  the  opposite  side. 

The  dissection  of  the  muscles  of  the  neck  should  not  be 
prosecuted  farther,  until  those  of  the  face  are  dissected. 


TABLE  OF  THE  SUPERFICIAL  MUSCLES 
OF  THE  NECK. 

LATISSIMUS  COLLI,OR  PLATYSMA  MYOTDES.  OR.  By  ma- 
ny delicate  fleshy  fibres,  from  the  cellular  substance  which 
covers  the  upper  parts  of  the  deltoid  and  pectoral  muscles. 
They  pass  over  tlie  clavicle  adhering  to  it.  They  ascend 
obliquely,  to  form  a  thin  muscle,  which  covers  all  the  side  of 
the  neck. 

IN.  1.  The  fascia  on  the  base  of  the  lower  jaw;  2.  the  de- 
pressor anguli  oris,  and  the  fascia  on  the  cheek. 

USE.  It  is  said  to  assist  the  depressor  anguli  oris  in  draw- 
ing the  skin  of  the  cheek  downwards ;  and,  when  the  mouth 
is  shut,  it  draws  all  that  part  of  the  skin  to  which  it  is  con- 
nected below  the  lower  jaw,  upwards.  The  true  use  of  th*- 
muscle,  is,  to  assist  the  respiration  and  circulation. 


185 

STERNO  CLEIDO  MASTOTDEUS.  OR.  1.  The  top  of  the 
tsterjmrn,  near  its  junction  with  the  clavicle;  2.  the  upper  and 
anterior  part  of  the  clavicle. 

IN.  The  mastoid  process  of  the  temporal  bone  and  mastoi.- 
dean  angle. 

USE.  To  turn  the  head  to  one  side,  and  bend  it  forwards. 

STERNO  HYOIDEUS.  OR.  1.  The  cartilaginous  extremity 
of  the  first  rib;  2.  the  upper  and  inner  part  of  the  sternum  ; 
3.  the  clavicle,  where  it  joins  with  the  sternum. 

IN.  The  base  of  the  os  hyoides. 

USE,  To  pull  the  os  hyoides  downwards. 

OMO  HYOIDEUS,  OR  BIVENTER  INFERIOR.  OR.  The  supe- 
rior costa  of  the  scapula,  near  the  semilunar  notch,  and  the 
ligament  that  runs  across  it.  Ascending  obliquely,  it  be- 
comes tendinous  below  the  -sterno  cleido  mastoid  muscle :  it 
grows  fleshy  again  towards  its — 

IN.  Into  the^base  of  the  os  hyoides. 

USE.  To  assist  in  pulling  down  the  os  hyoides. 

STERNO  THYROIDEUS.  OR.  The  edge  of  the  triangular 
portion  of  the  sternum,  internally,  and  from  the  cartilage  of 
the  first  rib. 

IN.  The  inferior  edge  of  the  thyroid  cartilage. 

USE.  To  draw  the  larynx  downwards. 

THYRO  HYOIDEUS.     OR.  The  lower  part  of  thyroid  car- 
tilage. 
l.\.  Part  of  the  base,  and  the  cornu  of  the  os  hyoides. 

CRTCO  THYROTDEUS.  OR.  The  side  and  fore  part  of  the 
eric oid  cartilage. 

IN.  The  lower  part  of  the  thyroid  cartilage,  and  its  infe- 
rior conm. 

Dro  ASTRICUS.  OR.  The  groove  in  the  mastcld  process  of 
the  temporal  bone  ;  it;  runs  downwards,  and  forwards.  The 
tendon  passes  through  the  stylo  hyoideus  muscle,  and  is  fixed 
by  a  ligament  to  the  os  hyoides  ;  then  the  tendon  is  reflected 
forward,  and  upward,  and  becoming  again  muscular,  it  has 
an 

IN.  Into  a  rough  part  of  the  lower  jaw,  behind  the  chin. 

USE.  To  open  the  mouth,  by  pulling  the  lower  jaw  down- 
wards;— when  the  jaws  are  shut,  to  raise  the  larynx,  aud^ 
consequently,  the  pharynx,  in  deglutition. 

MYLO  HYOIDEUS.     OR.  All  .the  inside  of  the  base  of  the 

lower  jaw. 

IN,  1.  The  lower  edge  of  the  basis  ef  the  os  hyoides;   $, 

iiito  its  fellow,  of  the  opposite  eide. 


186 

USE.  To  pull  the  os  hyoides  upwards. 
GENIO  HYOIDEUS.     OR.  A  rough  protuberance  within  tht- 
arch  of  the  lower  jaw,  which  forms  the  chin. 
IN.  The  basis  of  the  os  hyoides. 
USE.  To  raise  the  chin. 

GENIO  Hro  GLOSSUS.  OR.  The  rough  protuberance  on 
the  inside  of  the  lower  jaw. 

IN.  The  tip,  middle,  and  root  of  the  tongue,  and  base  of 
the  os  hyoides,  near  its  cornu. 

USE.  According  to  the  direction  of  its  fibres,  to  move  the 
tongue;  to  draw  its  root,  and  the  os  hyoides,  forwards  ;  ,and 
to  thrust  the  -tongue  out  of  the  mouth. 

HYO  GLOSSUS.  OR.  The  base,  cornu,  and  appendix  of 
the  os  hyoides* 

IN.  The  side  of  the  tongue. 

USE.  To  pull  the  tongue  into  the  mouth,,  or  to  draw  it 
Downwards. 

LINGUALIS.     OR.  Base  of  the  tongue. 
IN.  Tip  of  the  tongue. 

STYLO  HYOIIJEUS.  OR.  The  middle  and  inferior  part  of 
the  styloid  process. 

IN.  The  os  hyoides,  at  the  junction  of  the  base  and  cofnu, 
USE.  To  pull  the  os  hyoides  upwards. 

STYLO  GLOSSUS.  OR.  The  styloid  process,  and  from  & 
ligament  that  connects  that  process  to  the  angle  of  the  lowo? 
jaw. 

IN.  The  root  of  the  tongue,  being  insensibly  lost  oa  the 
side  and  tip  of  the  tongue. 

USE.  To  draw  the  tongue  laterally  or  backwards. 

STYLO  PHARYNGEUS.    OR.  The  root  of  the  styloid  process. 
IN.  The  side  of  the  pharynx  and  bade  part  of  the  thyroid 
cartilage* 


187 

DISSECTION 

OF  THE 

MUSCLES  OF  THE 


IF  the  scull  be  still  entire,  an  incision  should  be  made,, 
through  the  skin ,  from  the  middle  of  the  parietal  bone  to  the  ex- 
ternal part  of  the  eye-brow,— and  another,  from  the  crown  to 
the  tip  of  the  nose.  The  object  of  the  first  incision,  is,  to  expose 
the  muscular  fibres  of  the  Occipito  Frontalis  ;  and  that  of  the 
second,  to  show  those  fibres  which  pass  down  on  the  nose. 
The  next  incision  is  to  be  made  in  a  semicircular  direction 
over  the.  eye-brow,  so  as  to  meet  the  two  first  incisions. 
Another  may  then  be  made  under  the  eye-brow,  and  be  con- 
tinued round  the  orbit,  so  that  the  eye-brow  will  be  left,  and 
the  fibres  of  the  Orhicularis  Oculi  be  exposed. 

After  completing-  the  dissection  of  the  occipito  frontalis 
and  the   orbicularis   oculi,   with  the  Corrugator  Supercilii, 
which  will  be  exposed  by  cutting  through  the  nasal  fibres  of 
the  occipito  frontalis,  we  should  pass  to  the  dissection  of  the 
muscles  of  the  mouth. 

An  incision  is  to  be  made  round  the  mouth,  leavivg  a  small- 
part  of  the  lip :  this  will  expose  the  Orbicularis  Orw,  into 
which  the  other  muscles  are  inserted.  By  then  carrying  an 
incision  from  the  zygomatic  process  to  this  circular  cut,  the 
Zygumatic  Muscles  will  be  exposed ;  and  if  another  is  con- 
tinued down  to  the  angle  of  the  jaw,  from  the  same  point, 
the  fibres  of  Masseter  will  be  seen  ;— but  in  doing  this,  we 
must  take  care  that  we  do  not  wound  the  parotid  duct,  which 
grosses  the  face,  nearly  in  a  line  drawn  from  the  upper  part 
of  the  lobe  of  the  ear,  to  the  ala  of  the  nose. 

By  dissecting  down  the  flap  of  skin  between  the  two  last 
fijts,  the  Buccinator  will  be  exposed.  A  large  portion  of  fat 
will  be  generally  found  running  between  this  muscle  and  the 
edge  of  the  masseter,  but  it  is  so  loosely  attached,  that  if 
may  be  pulled  away  with  the  fingers. — As  in  this  dissection, 
we  do  not  value  the  skin,  we  should  make  another  cut  from 
the  angle  of  the  mouth,  obliquely,  towards  the  outer  part  of 
the  jaw,  so  as  to  expose  the  Triangularis,  or  Depressor  An- 
gttli  Oris. 

The  muscles  which  have  been  named,  may  be  fully  sjiowft. 
by  dissecting  in  the  direction  of  ti?  incisioira  pointed  out  . 


188 

but  the  dissection  of  many  of  the  muscles  of  the  mouth  will 
be  found  very  difficult,  and  particularly  those  about  the  chin, 
on  account  of  the  mixture  of  their  fibres  with  the  integu- 
ments into  which  they  are  inserted.* 

The  muscles  of  the  nose  and  upper  lip,  may  now  be  dis- 
sected. 

A  cut  should  be  made  from  the  inner  angle  of  the  orbit, 
down  to  the  middle  of  the  circular  cut  round  the  mouth  :  this 
will  expose  the  fibres  of  the  Levator  Lftbii  Superior^  Alec- 
yue  JVcm,  between  which,  and  the  zygomaticus,  the  Levator 
Anguli  Oris  will  be  found;  and  if  we  raise  the  levator  labii 
superioris  alseque  nasi,  the  Levator  Propriwt  will  be  seen. 
The  Compressor.,  or  Dilator  JVhHs,  may  be  exposed,  by  dis- 
secting down  from  the  cut  that  was  made  from  the  tip  of  the 
nose  towards  the  last  incision. 

There  are  still  two  muscles  to  be  shown,  viz.  the  Super- 
fc.w.9,  or  Levator  Labii  Inferiors*  and  the  Depressor  Labii  Su- 
perioris. To  show  the  superbus,  we  should  turn  flown  the 
lower  lip,  and  dissect  the  membrane  from  the  root  of  the  in- 
cisores. 

The  Depressor  Labii  Superioris  will  be  found,  by  lifting 
the  upper  lip,  and  raising  the  membrane  which  covers  the 
upper  incisores. 


TABLE  OF  THE  MUSCLES  OF  THE  FACE. 

ARRANGED    IN    THE    ORDEJR    IN    WHICH    THEY    ARE    TO  BE  His 
SECTED. 

OrcipfTo  FFIONTALIS.    OR.  The  superior  transverse  ridgr- 
of  the  occipital  bone,  and  part  of  .the  temporal  bone.     A  ten- 
dinous web  covers  the   cranium,  which  terminates  forward 
deahy belly  (the  frontal  portion:)  this  muscular  portion 
ers  the  frontal  bone. 

I.N.  1.  Into  the  orbicularis  palpebrarum  ;  2.  into  the  skin  of 
flic  eye-brows.  It  sends  down  a  fleshy  slip  upon  the  nose. 

USE.  It  draws  up  the  skin  of  the  forehead,  and  raises  the 
r-ye- brows, 

CORRUG  \TOTI  SUPERCILII.  OR.  The  internal  angular 
process  of  the  os  frontis. 

IK,  The  skin  under  the  eye-brows,  near  the  middle  0  the 
arch. 

*The  dissection  of  these  muscles  will  be  facilitated  by  put- 
ting a  little,  horsehair  into  the  mouth. 


189 

USE.  We  have  no  power  over  the  individual  muscle.  The 
corrugators  knit  the  eye-brows,  and  are  antagonists  of  the 
last  muscle. 

ORBICULARTS  OCULI.  OR.  1.  By  many  fibres,  from  the 
edge  of  the  orbitary  process  of  the  superior  maxillary  bone  ; 
'2.  from  a  tendon  near  the  inner  angle  of  the  eye.  These 
run  a  little  downwards,  then  outwards,  over  the  upper  part 
of  the  cheek  covering  the  under  eye-lid,  and  surround  thp 
external  angle.  Being  loosely  connected  only  to  the  skin 
and  fat,  they  run  over  the  supercilary  ridge  of  the  os  fron- 
tis,  towards  the  inner  canthus,  where  they  intermix  with 
those  of  the  occipito  frontalis  and  corrugator  supercilii ; — 
then,  covering  the  upper  eye-lid,  they  descend  to  the  inner 
angle,  opposite  to  the  inferior  origin  of  this  muscle,  adhering 
firmly  to  the  internal  angular  process  of-  the  os  frontis,  and 
to  the  short  round  tendon  which  serves  to  fix  the  palpebree 
and  muscular  fibres  arising  from  it. 

IN.  The  nasal  process  of  the  superior  maxillary  bone,  co- 
vering1 a  part  of  the  lachrymal  sac. 

This  muscle  should  be  divided  into  the  external  and  inter- 
nal muscles, — the  internal  is  the  Ciiiaristh&t  covers  the  car- 
tilages of  the  eye-lids,  which  are  called  cilia  or  tarsi. 

OH.BTCULARIS  Oais.  This  consists  of  circular  fibres,  which 
surround  the  mouth,  and  constitute  a  great  part  of  the  thick- 
ness of  the  lips. 

USE.  To  shut  the  mouth,  and  to  oppose  the  muscles  which 
converge  to  be  inserted  into  the  lips. 

Part  of  this  is  sometimes  described  as  a  distinct  muscle, 
viz. 

NASALIS  LABII  SUPERIORIS.  OR.  The  fibres  of  theorbi- 
cularis  muscle. 

IN.  The  lower  part  of  the  septum  nasi. 

USE.  To  draw  down  the  point  of  the  nose,  by  operating  on 
the  elastic  septum. 

ZYGOMATICUS  MAJOR.  OR.  The  zygomatic  process  of 
the  os  malae. 

IN.  The  angle  of  the  mouth. 
USE.  To  draw  the  corner  of  the  mouth  obliquely  upwards. 

ZYGOMATICUS  MINOR. — (Often  wanting.)  OR.  The  up- 
per prominent  part  of  the  os  malee,  above  the  origin  of  the 
former  muscle. 

IN.  The  upper  lip,  near  the  corner  of  the  mouth,  along 
with  the  levator  anguli  oris. 

USE.  To  draw  the  corner  of  the  mouth  upwards. 


190 

DEPRESSOJR  ANGUI.I  ORIS.  OR.  The  base  of  the  maxillary 
bone  near  the  chin. 

IN.  The  angle  of  the  mouth,  uniting  with  the  zygomaticus 
majorandlevator  anguli  oris. 

USE.  To  pull  down  the  corner  of  the  mouth. 

DEPRESSOR  LABII  INFT  RTORIS,  OR  QUADRATUR  GEN*:. 
On.  Broad  and  fleshy,  intermixed  with  fat,  from  the  inferi- 
or part  of  the  lower  jaw  next  the  chin ;  runs  obliquely  up- 
wards, and  is 

IN.  Into  the  edge  of  the  under  lip;  extends  along  one  half 
of  the  lip,  and  is  lost  in  its  red  part. 

USE.  To  pull  the  under  lip  and  the  skin  of  the  side  of  the 
chin  downwards,  and  a  little  outwards. 

BUCCINATOR.  OR.  1.  The  alveolar  part  of  the  lower  jaw  ; 
<?.  the  fore  part  of  the  root  of  the  coronoid  process  /  3,  the 
upper  jaw;  4.  the  pterygoid  process  of  the  sphenoid  bone. 

IN.  'The  angle  of  the  mouth,  within  the  orbicularis  oris. 

USE.  To  draw  the  angle  of  the  mouth, — to  turn  the  mor- 
sel in  the  mouth,  and  to  place  it  under  the  action  of  th^ 
grinding  teeth. 

LEVATOR  LABII  SUPERIORIS  ALJEQUE  NASI.  OR.  The 
nasal  process  of  the  superior  maxillary  bone,  where  it  joins 
the  os  frontis. 

IN.  1.  The  upper  lip  ;  2.  the  ala  nasi. 
•     USE.  To  raise  the  upper  lip  and  dilate  the  nostril. 

By  some,  the  next  muscle  is  described  as  part  of  this. 

LEVATOR  LABII  SUPERIORIS   PROPRIUS.     OR    The  supr- 
rior  jaw  bone,  above  the  foramen  infra  orbitale. 
IN.  The  upper  lip  and  orbicularis  muscle. 

LEVATOR  ANGUI.I  ORIS,  or  LEVATOR  LABIORUM  COMMT;- 
MS.  OR.  The  hollow  on  the  face  of  the  superior  maxillary 
bone,  between  the  root  of  the  socket  of  the  first  dens  molari* 
and  the  foramen  infra  orbitale. 

IN.  The  angle  of  the  mouth. 

USE.  To  draw  the  corner  of  the  mouth  upwards. 

COMPRESSOR  NARIS.  It  consists  of  a  few  fibres,  which 
run  along  the  cartilage  of  the  nose,  in  an  oblique  direction, 
towards'the  dorsurn  of  the  nose. 

OH,  The  anterior  extremity  of  the  os  nasi  and  nasal  pro- 
cess of  the  superior  maxillary  bone,  where  it  meets  with 
some  of  the  fibres  descending  from  the  occipito  frontalis  mus- 
cle. 

IN..  The  root  of  the  ala  nasi. 


191 

ehend  this  muscle  is  to  expand  the  nostril.    A* 
its  name  implies,  it  is  supposed  to  compress  the  nose. 

JJEVATOR  LABII  INFERIORIS,  OR  SUPEBBUS.  OR.  The 
lower  jaw,  at  the  roots  of  the  alveoli  of  the  two  dentes  incisi- 
vi,  and  of  the  caninus. 

IN.  The  skin  of  the  chin.' 

USE.  To  pull  up  the  chin,  and,  consequently,  to  raise  and 
protrude  the  lip. 

DEPRESSOR  LABII  SUPERIORTS  AI.JEQUE  NASI.  OR.  The 
superior  maxillary  bone,  immediately  ahove  the  joining  of  the* 
gums  with  the  two  dentes  incisivi  and  the  deris  caiiiniis. 

IN.  The  upper  lip  and  root  of  the  ala  nasi. 

USE.  To  draw  the  upper  lip  and  ala  nasi  downwards,  and 
•  o  compress  the  nostril. 


DISSECTION 


DEEP  MUSCLES  OF  THE  NECK. 


AFTER  dissecting  the  small  muscles  of  the  face,  we  should 
remove  them,  and  then  examine  the  muscles  of  the  jaw. 

The  Temporal™  and  Jti'asseter  may  be  easily  dissected ; 
but  before  we  ca.n  form  a  correct  idea  of  the  other  muscles; 
and  of  the  deep  muscles  of  the  throat,  we  must  inake-a.  sec- 
tion of  the  jaw.  The  most  convenient  method  is,  to  cut  out 
the  portion  which  is  between  the  symphysisand  the  insertion 
of  the  mnsseter:  if  we  leave  a  small  portion  of  the  symphy- 
sis,  we  shall  still  have  a  very  good  view  of  the  muscles 
which  rim  from  it  to  the  os  hyoide-s. 

If  after  examining-  these  muscles,  we  pull  the  jaw  towards 
the  ear.  we  shall  be  enabled  to  dissect  part  of  the  Pteryspv- 
dcita  Externus,  and  Ptery^oideus  Internus.  (Here  I  may  ob- 
rferve,  that  the  young  student  is  often  confused  in  making  the 
dissection  of  these  two  muscles,  in  consequence  of  the  ex- 
ternus  being-  really  the  most  internal  of  the  two.)  To  ex- 
pose the  pterygoidei  completely,  it  will  be  necessary  to  rut 
away  the  insertion  of  the  temporalis,  and  the  origin  of  tfa« 
mussetor. 


192 

After  the  origin?  and  insertions  of  the  two  pterygoid  have 
been  seen,  the  jaw  should  be  entirely  removed,  which  will 
be  easily  done,  by  forcing  the  condyle  from  the  glenoid  cavi- 
ty.* The  mouth  is  then  to  be  thoroughly  cleaned ;  and  to 
do  this  effectually,  it  will  be  necessary  at  the  same  time,  to 
push  pieces  of  sponge  into  the  larynx,  pharynx,  and  poste- 
rior nares,  as  the  secretions  are  constantly  pouring  from 
these  cavities.  A  strong  piece  of  twine  should  be  put  througli 
the  tongue,  by  which  it  may  be  pulled  out  and  extended. 

When  we  look  into  the  throat,  we  shall  see  the  Soft  Pal- 
erfe,  or  Velum  Pendulum  Palati.  At  the  posterior  part  of 
this,  we  see  the  Uvula,  and  on  the  lateral  parts,  the  two 
Arches, — the  Anterior  and  Posterior.  The  space  which  is? 
between  the  two,  being  occupied  by  the  Tonsil,  or  Amyg- 
dala. 

The  anterior  arch  is  formed  by  a  fold  of  the  mucous  mem- 
brane, arid  a  few  muscular  fibres ;  these  may  be  now  expos- 
ed :  they  form  the  muscle  which  is  called  Constrictor  Ixthmi 
Faitcium,  The  posterior  arch  is  ali?o  formed  by  a  muscle, 
(the  Potato  Pharyngeus^)  but  this  should  not  be  dissected  yet. 

We  have  now  two  very  difficult  muscles  to  examine,  viz. 
the  Circwmflexus  or  Tensor  Palati*  and  the  Levator  Palati. 
Before  these  can  be  exposed,  all  the  fibres  of  the  pterygoidei 
must  be  removed ;  and  as  they  arise,  one  from  each  side  of 
the  Eustachian  7W;e,  we  should  pass  a  probe  into  it,  so  as  to 
mark  its  situation.  The  tube  will  be  seen  by  raising  the  soft 
pulate. 

The  circumflexus,  or  tensor  will  be  found  arising  from  the 
temporal  bone,  auJ  covering  the  upper  part  of  the  Eusta- 
cliian  tube;  its  tendon  passes  towards  the  internal  pterygoid 
process  of  the  sphenoid  bone;  and  after  passing  over  the  ha- 
rnulap.  or  hook-like  process,  in  the  manner  of  a  rope,  it  is 
spread  upon  the  soft  palate. 

The  levator  arises  immediately  from  the  lower  edge  of 
the  tube,  from  which  it  passes  directly  to  the  middle  of  the 
palate. 

The  palato  pharyngeus,  which  forms  the  posterior  arch, 
will  be  found  immediately  below  the  last  muscle ;  it  passes 
down,  to  unite  with  the  constrictors  of  the  pharynx. 

The  muscular  fibres  which  are  described  as  forming  pa$t 
ef  the  uvula,  and  which  are  called  Azygos  Uvulae,  may  be 
seen  by  merely  raising  the  mucous  membrane. 

The  next  stage  of  the  dissection  should  be,  to  display  the 
three  constrictors  of  the  pharynx ;  but  previous  to  commene-  - 

*  It  will  be  a  great  advantage  to  this  view,  if  hnth  sides  of 
the  jaw  can  be  femoved. 


193 

mg  the  dissection  of  them,  the  pharynx  should  be  stuffed  with 
baked  horse  hair,  so  as  to  make  the  fibres  tense.  —  By  then 
pulling  the  parts  over  to  one  side,  the  bag  of  the  pharynx 
may  be  exposed  ;  but  the  dissection  will  be  much  facilitated, 
if  the  trachea  and  pharynx  are  cut  through  immediately 
above  the  sternum,  for  then  the  parts  may  be  held  up,  so  that 
we  may  easily  remove  the  cellular  membrane  ;  arid  this  is  all 
that  is  necessary  to  be  done,  to  show  the  three  orders  of  fi- 
bres. Those  which  are  close  upon  the  occiput,  form  the 
Constrictor  Superior  ;  the  next,  which  run  obliquely  down  to 
the  thyroid  cartilage,  are  called  the  Constrictor  Medium  ;  ami 
the  third,  which  are  continued  up  from  the  oesophagus  to  the 
os  hyoides,  form  the  Inferior. 

As  we  have  now  finished  the  dissection  of  all  the  muscles 
Which  run  to  the  throat,  we  may  cut  out  the  larynx,  and  the 
pharynx,  with  the  tongue  ;  and  after  removing  the  muscles 
which  rnay  have  been  left  attached  to  them,  we  should  Jay 
open  the  bag  of  the  pharynx. 

We  may  now  take  a  cursory  view  of  the  parts  which  are 
seen  here.  (They  will  be  described  more  particularly  after- 
wards.) 

We  shell  see  the  termination  of  the  wide  part  of  the  Pha- 
rynx in  the  (Esophagus;  —  the  opening  of  the  Larynx  will  be 
also  distinct  ;  and  we  may  now  understand,  that  when  the 
tongue  is  pushed  back,  this  opening  will  be  closed  by  the 


If  we  raise  the  epiglottis,  we  shall  see  the  Glottis,  which 
us  the  space  between  the  two  Ayrtenoid  Cartilages.  The 
deepest  part  of  this  opening,  is  called  the  Rima  Gfottidis,  at 
it  appears  like  a  slit  formed  between  the  two  cords  which 
are  called  the  Cordcc  locales.  —  On  each  side  of  these  cords, 
there  is  a  little  cavity,  which  is  called  Sacculus  Laryngis. 

The  pharynx  and  tongue,  with  the  os  hyoides,  may  now 
be  dissected  from  the  larynx.  —  If  the  soft  mucous  coat  is 
then  carefully  raised  with  the  forceps,  and  scissors,  from  the 
back  of  the  larynx,  some  of  the  muscles  which  move  the  ir>- 
ternal  cartilages  will  be  exposed  ;  —  the  first  that  are  seen, 
will  be  the  two  which  run  from  the  back  part  of  the  cricoid 
cartilage  to  the  arytenoid  cartilages,  whence  they  are  called 
the  Crico  Arytenoidci  Poslici.  By  then  pulling  the  thyroid 
cartilage  a  little  from  the  cricoid,  a  similar  set  of  fibres  will 
be  seen  on  each  side,  passing  from  the  lateral  part  of  the  cri- 
coid to  the  arytenoid  ;  these  are  called  the  Crico  Arytewoidei 
Laterales.  A  considerable  mass  of  fibres  may  now  be  ob- 
served, passing  from  one  arytenoid  cartilage  to  the  other, 
This  is  divided  into  three  muscles,  there  being  a.  Transfer- 
xnltSi  and  two  Oblique.  The  fibres  which  run  directly  a« 
R 


194 

ibrm  the  transversalis,  and  may  be  always  easily  shown ;  but 
the  oblique  are  so  small,  being  merely  three  or  four  delicate 
fibres  that  pass  from  the  base  of  one  cartilage,  to  the  tip  of 
the  other,  that  they  are  often  cut  away  with  the  mucous 
membrane. 

There  are  still  three  other  muscles  described,  as  running 
from  one  cartilage  to  another  ;  but  it  will  be  only  in  the  la- 
rynx of  a  very  powerful  man,  that  we  shall  see  them  dis- 
tinctly. The  names  which  are  given  to  them,  are  suffi- 
ciently descriptive  of  their  course, — Thyro  Arytenoideus^ 
Thyro  Epiglottideus,  Aryteno  Epiglottideus.  The  only  mus- 
cle which  is  on  the  fore  part  of  the  larynx,  is  the  crico  thy- 
roideus, — which,  in  the  first  dissection  of  the  neck,  was 
seen  passing  from  the  cricoid  to  the  thyroid  cartilage. 

We  may  now  remove  the  small  muscles,  so  as  to  show  the 
cartilages  and  their  ligaments, — which  are  named  according 
to  the  cartilages  which  they  unite  together. 


TABLE  OF  THE  MUSCLES  OF  THE  JAW,  AND 
OF  THE  DEEP  MUSCLES  OF  THE  THROAT. 

TEMPORALIS.  OR.  The  semicircular  ridge  of  the  lower 
and  lateral  parts  of  the  parietal  bone ;  2.  the  pars  squamosa 
of  the  temporal  bone  ;  3.  the  external  angular  process  of  the 
OB  frontis  ;  4.  the  temporal  process  of  the  sphenoid  bone  ;  5. 
it  is  covered  by  an  aponeurosis,  from  which  it  also  takes  an 
ftriein.  The  muscle  pa,?emg  under  the  jugurr^  has  for  its 

IN.  The  coronoid  process  of  the  lower  jaw,  which  it  grasps 
with  a  strong  tendon. 

USE.  To  raise  the  lower  jaw. 

MASSETER.  OR.  1.  The  superior  maxillary  bone,  where 
it  joins  the  os  males  ;  2.  the  inferior  part  of  the  zygoma,  in  its 
whole  length. 

IN.  The  outside  of  the  angle  of  the  upright  part  of  the 
lower  jaw. 

USE.  To  pull  up  the  lower  jaw,  for  performing  the  grind- 
ing, or  lateral  motions  therei 

PTERYGOIDEUS  INTFRNUS.  OR.  1.  The  inner  and  upper 
part  of  the  internal  plate  of  the  pterygoid  process  of  the 
sphenoid  bone  ;  2.  the  palatine  bone.  It  fills  the  space  be- 
tween the  two  plates  of  the  pterygcid  process. 

IN.  The  inside  of  the  angle  of  the  lower  jaw. 

USE.  To  move  the  jaw  laterally. 


195 

PTERTGOIDKUS  EXTERNUS.  OR.  1.  The  outside  of  the 
external  plate  of  the  pterygoid  process  of  the  sphenoid  bone ; 
2.  part  of  the  unper  maxillary  bone  adjoining. 

IN.  The  outside  of  the  angle  of  the  upright  part  of  the 
lower  jaw. 

USE.  To  pull  up  the  lower  jaw,  for  performing  the  grind- 
ing, or  lateral  motions  there. 

CONSTRICTOR  ISTHMI  FAUCIUM.  OR.  The  side  of  the 
tongue,  near  its  root ;  from  thence  running  upwards,  within 
the  anterior  arch  of  the  fauces. 

IN.  The  middle  of  the  velum  pendulum  palati,  at  the  root 
of  the  uvula.  It  is  connected  with  its  fellow. 

TENSOR,  or  CIRCUMFLEXUS  PALATI.  OR.  1.  The  spinous 
process  of  the  sphenoid  bone,  behind  the  foramen  ovale;  2. 
the  Eustachian  tube.  It  then  runs  down  along  the  pterygoi- 
deus  internus  muscle,  passes  over  the  hook  or  internal  plate 
ofthe  pterygoid  process,  and  spreads  into  a  broad  membrane. 

IN.  The  velum  pendulum  palati.  Some  of  its  posterior 
fibres  join  with  the  constrictor  pharyngis  superior,  and  pala- 
to-pharyngeus. 

USE.  To  stretch  and  draw  down  the  velum  palati. 

LEVATOR  PALATI.  OR.  The  extremity  of  the  pars  petror 
.su  of  the  temporal  bone,  near  the  Eustachian  tube,  and  from 
the  membranous  part  ofthe  same  tube. 

IN.  The  velum  pendulum  palati,  and  the  root  ofthe  uvula. 
It  unites  with  its  fellow. 

USE.  To  draw  the  velum  upwards,  so  as  to  shut  the  pos- 
terior nares. 

PALATO-PHARYNGEUS.  OR.  The  middle  of  the  velum 
pendulum  palati,  and  from  the  tendinous  expansion  of  the 
circumflexor  palati.  The  fibres  are  collected  wiUiin  the  pos- 
terior arch  behind  the  amygdalae,  and  run  backwards,  to  the 
top  and  lateral  part  of  the  pharynx,  where  the  fibres  are 
scattered,  and  mix  with  those  of  the  stylo-pharyngeus. 

I\.  The  edge  of  the  upper  and  back  part  of  the  thyroid 
cartilage,  some  of  its  fibres  being  lost  between  the  membrane 
of  the  pharynx  and  the  two  inferior  constrictors, 

Us  F..  Draws  the  uvula  and  velum  downwards,  and  back- 
wards ;  and,  at  the  same  time,  pulls  the  thyroid  cartilage 
and  pharynx  upwards.  In  swallowing,  it  thrusts  the  food 
from  the  fauces  into  the  pharynx. 

N.  B,  A  few  of  the  fibres  of  this  muscle  have  been  called, 

SAI.PINGO-PHARYNGEUS.  And  supposed  to  operate  on  the 
mouth  of  the  Eustachian  tube. 


196 

A  a  re  os  UVULJE.     OR.  The  extremity  of  the  suture  which 
joins  the  palate  bones. 
IN.  The  tip  of  the  uvula. 
USE.  Raises  the  uvula,  and  shortens  it. 

MUSCLES  ON  THE  BACK  PART  OF  THE 
PHARYNX. 

CONSTRICXTOR  PHARYNGIS  INFERIOR.  OR.  t.  The  side  of 
f  he  thyroid  cartilage  ;  2.  The  cricoid  cartilage.  This  mus- 
cle is  the  largest  of  the  three  constrictors. 

IN.  It  joins  with  its  fellow,  on  the  back  of  the  pharynx; 
the  superior  fibres  run  upwards,  and  cover  part  of  the  mid- 
file  constrictor  ;  the  inferior  fibres  run  more  transversely,  and 
surround  the  oesophagus. 

USE.  To  compress  the  pharynx. 

CONSTRICTOR  PHARYNGIS  MEDIUS.  OR.  The  appendix 
and  corim  of  the  os  hyoides,  and  the  ligament  which  connects 
the  os  hyoides  and  the  thyroid  cartilage  ;  the  fibres  of  the 
superior  part  run  upwards,  and  cover  a  considerable  part  of 
the  superior  constrictor. 

IN.  The  middle  of  the  cuneiform  process  of  the  occiput : 
and  it  is  joined  to  its  fellow  at  the  back  of  the  pharynx. 

USE.  To  compress  the  pharynx,  and  draw  it  upwards. 

CONSTRICTOR  PHARYNGIS  SUPERIOR.  OR.  1.  The  cunei- 
form process  of  the  occiput,  near  the  condyloid  foramina ;  2.. 
the  pterygoid  process  of  the  sphenoid  bone  ;  3.  alveolar  pro- 
cess of  the  upper  jaw  ;  4.  the  lower  jaw. 

IN.  A  white  line,  in  the  middle  of  the  pharynx,  where  it 
joins  with  its  fellow,  and  is  covered  by  the  constrictor  medius, 

USE.  To  compress  the  upper  part  of  the  pharynx,  and 
draw  it  upwards. 


TABLE  OF  THE  MUSCLES  WHICH  ARE  FOUND 
PASSING  BETWEEN  THE  CART1LATES  OF 
THE  LARYNX. 

CRICO-ARYT^NOIDETJS  POSTICUS.  OR.  Fleshy,  from  the 
back  part  of  the  cricoid  cartilage. 

IN.  The  posterior  part  of  the  base  of  the  arytaenoid  carti- 
lage. 

USE.  To  open  the  rima  glottidis  a  little,  and,  by  pulling 
back  the  aryteenoid  cartilage,  to  stretch  the  ligament,  so  &s 
to  make  it  tense.  , 

I 


197 

LATERALTS.  OR.  From  the  cricoid 
^  rtilajre,  laterally,  where  it  is  covered  by  part  of  the  thyroid. 

IN.  Tile  side  of  the  base  of  the  arytsenoid  cartilage,  near 
the  former. 

USE.  To  open  the  rirna  glottidis,  by  pulling  the  ligament? 
from  each  other. 

ARYT«NOIDEUS  TRA.NSVFRSTJS.  P-^ses  from  the  side  of 
one  arytsnoid  cartilage,  (its  origin  oxronding  from  near  its 
articulation,  with  the  cricoid,  to  near  its  tip,,  towards  the  oth- 
er arytsenoid  cartilage. 

USE.  To  shut  the  rima  glottidis,  by  bringing  these  two 
cartilages,  with  their  ligaments,  nearer  to  one  another. 

ART.^NOIDEUS  OBLTQUUS.  OR.  The  base  of  one  arytae- 
noid  cartilage  ; — crosses  its  fellow. 

IN.  Near  the  tip  of  the  other  aryt?enoid  cartilage. 

USE.  When  both  act,  they  pull  the  arytaenoicl  cartilage 
towards  each  other. 

Very  often,  one  of  these  is  wanting. 

THYREO  ARYT^NOIDEUS.  OR.  The  under  and  back  part 
of  the  thyroid  cartilage. 

IN.  The  arytaenoid  cartilage,  higher  up  and  farther  for- 
wards than  the  crico  lateralis. 

AHYT^NO-EPIOLOTTIDEUS.     Consisting  of  a  few  fibres. 
Oa.  From  the  side  of  the  arytsenoid  cartiiage. 
IN.  The  epiglotis. 
USK,  To  pull  down  the  epiglottis  on  the  glottis. 

THYREO-EPIGLOTTIDEUS.     OR.  The  thyroid  cartilage. 
IN.  The  side  of  the  epiglottis. 
USE,  To  expand  the  epiglottis. 

N.  B.  The  crico  thyroideus  is  described  with  those  of  the 
throat. 


198 

DISSECTION 

OF 

THE  MUSCLES 

ON 

THE  FORE  PART  OF  THE  CHEST. 


The  first  muscle  which  is  to  be  dissected,  is  the  Pectoralis 
Major.  After  the  fibres  have  been  made  tense,  by  extend- 
ing the  arm  and  throwing  it  out  from  the  body,  an  incision  is 
to  be  carried  through  the  skin,  from  opposite  to  the  union  be- 
twoen  the  bone  and  cartilage  of  the  fifth  rib,  to  the  inside  of 
the  arm,  at  about  a  hand's  breadth  below  the  shoulder.  The 
muscle  may  be  then  easily  exposed,  by  dissecting  in  the  line 
of  the  fibres,  and  by  carrying  the  skin  first  towards  the  lower 
part  of  the  chest,  and  then  towards  the  clavicle  ;  but  we  must 
rsc  jllect,  that  the  course  of  the  fibres  changes  a  little  as  we 
approach  the  clavicle. 

Upon  the  lower  edge  of  the  pectoralis,  we  shall  see  part  of 
Serratus  Major  Jlntlcus.  The  fibres  of  this  muscle  are  more 
difficult  to  dissect  than  those  of  the  pectoralis,  because  their 
course  changes  according  to  the  ribs  from  which  they  arise  ; 
in  consequence  of  this  we  shall  not  be  able  to  make  long  in- 
cisions, as  we  could  in  dissecting  the  last  muscle,  but  we 
must  carry  the  knife  in  a  sweeping  direction  along  each  por- 
tion. In  tracing  the  fibres  towards  their  origin,  we  shall  see 
the  slips  of  the  obliquus  externus,  with  which  they  indigi- 
tate  ;  but  we  shall  not  yet  be  able  to  follow  the  muscle  to  its 
insertion. 

Before  the  insertion  of  the  serratus  can  be  shown,  several 
muscles  must  be  partially  dissected,  particularly  the  Latissi,- 
mm  Dorsi,  the  margin  of  which  will  be  found  running  across 
tire  axilla  ; — this  portion  of  the  latissimus  should  be  exposed 
as  far  as  i'ts  insertion  into  the  humerus,  and  when  this  is 
done,. we  shall  see  that  the  upper  and  lower  boundaries  of 
the  axilla  are  formed  by  the  pectoralis  major  and  the  latissi- 
mus dorsi. 

A  large  quantity  of  fat  and  glands  will  be  seen  between  the 
two  muscles,  and  also  many  vessels  and  nerves, — whichv 
though  they  are  very  important,  may  be  cut  away  in  the  pre- 
sent dissection. 


199 

Before  tracing  the  lafjssimus'  dorsi,  or  serratus  magnus, 
farthcU'  b  xck  wo  should  dissect  upor;  the  l^we-  edge  of  the 
pectoral!^  mr.ij  .)*•,  so  as  to  expose  the  margin  of  the  Pectoralis 
Minor,  or  Serratm  .Minor  Jl-rdicus.  After  p,  small  portion  of 
this  is  shown,  we  should  raise  the  pectorahe  major  This 
may  be  done  by  cutting  its  origins  from  the  cartilages  of  the 
ribs,  and  by  then  carrying  it  towards  the  sternum,  from  which 
it  is  also  to  be  separated,  as  far  as  to  the  clavicle.  In  doing 
this,  we  should  keep  all  the  cellular  membrane  attached  to  its 
lower  surface,  by  which  we  shall  at  once  clean  the  surface  of 
the  pectoralis  minor,  and  at  the  same  time  show  a  considera- 
ble part  of  the  serratus  magnus. 

The  lattissimus  dorsi  may  now  be  followed  towards  the 
back  part  of  the  chest,  and  by  then  removing  the  fat,  &c. 
from  its  inner  surface,  we  shall  expose  the  edges  of  the  Sub- 
scapularis  and  Teres  Major  muscles.  These  muscles  are 
not  yet  to  be  followed  to  their  insertions,  but  by  making 
their  bellies  distinct,  we  shall  expose  the  insertion  of  the  ser- 
ratus magnus  into  the  base  of  the  scapula. 

The  whole  of  the  pectoralis  major  may  now  be  cut  away, 
except  a  small  portion,  which  should  be  left  attached  to  the 
deltoid  ; — this  will  enable  us  to  see  the  Subclavius,  which 
runs  from  the  first  rib  to  the  clavicle. 

If  we  cut  through  the  pectoralis  minor,  we  shall  have  an 
opportunity  of  seeing  the  two  sets  of  Intercostal  Muscles  ;  for 
both  layers  are  found  in  the  middle  of  the  chest, — the  Exter- 
nal being  deficient  on  the  anterior,  and  the  internal  on  the 
posterior  part  of  the  ckest. 

The  muscle  '  which  is  called  Triangularis  Sterni  cannot  be 
seen  until  the  sternum  and  the  cartilages  of  the  ribs  are  re- 
moved. The  muscle  will  then  be  apparent  on  the  inside  of 
the  sternum,  without  any  dissection  being  necessary  to  show 
its  fibres. 


TABLE  OF  THE  MUSCLES  SITUATED  ON  THE 
FORE  PART  OF  THE  CHEST. 

PECTORALIS  MAJOR.  OR.  1.  The  cartilages  and  bodies 
of  the  fifth,  sixth  and  seventh  ribs  ;  here  it  intermixes  with 
the  external  oblique  muscle  of  the  abdomen  ;  2.  almost 'the 
whole  length  of  the  sternum  ;  3.  the  anterior  half  of  the 
clavicle. 

IN.  Outside  of  the  groove  for  lodging  the  tendon  of  tha 
long  head  of  the  biceps.  The  tendon  is  twisted  before  it  is 
inserted. 


200 

USE.  Tt5  move  the  arm- forwards,  or  to  draw  it  down,  or 
to  draw  it  towards  the  side. 

SERRATUS  MAGNUS,  or  ANTICUS.  OR.  The  nine  superior 
ribs,  by  digitations,  which,  resembling  the  teeth  of  a  saw,  the 
anatomist  calls  them  serrated  origins. 

IN.  The  whole  base  of  the  scapula,  internally,  between 
the  insertion  of  the  rhomboid  and  the  origin  of  the  subscap- 
ularis  muscles  ;  it  is,  in  a  manner,  folded  about  the  two  an- 
gles of  the  scapula. 

USE.  To  roll  the  scapula,  and  raise  the  arm. 

PECTORALIS  MINOR.  OR.  The  upper  edge  of  the  second, 
third  and  fourth  ;  or  the  third,  fourth  and  fifth  ribs,  near  their 
cartilages. 

IN.  The  coracoid  process  of  the  scapula. 

USE.  To  bring  the  scapula  forwards  and  downwards,  or 
to  raise  the  ribs  wjben  the  shoulder  is  fixed. 

SUBCLAVIUS.  OR.  The  cartilage  that  joins  the  first  rib  to 
the  sternum. 

IN.  Extensively  into  the  lower  part  of  the  clavicle. 
USE.  To  pull  the  clavicle  downwards. 

INTERCOSTALE.S    EXTTCRNT.     OR.     The  inferior  edge  of. 
the  rib,  the  whole  length  from  the  spine  to  near  the  joining 
ef  the  ribs  with  their  cartilages.     (From  this  to  the  sternum, 
there  is  only  a  thin  membrane  covering  the  internal  intercos- 
tal muscle.) 

IN.  The  upper  obtuse  edge  of  the  rib  below,  as  far  back  as 
the  spine. 

INTERCOSTALES  JNTFRNI.  OH.  Like  the  external  muscle ; 
the  fibres  run  down,  and  obliquely  backwards. 

IN.  Into  the  margin  of  the  rib  below.  (From  the  sternum 
to  the  angle?  of  the  ribs.) 

TRIANGUT.ARTS  STFRNI.  OR.  Frcm  the  posterior  surface 
«,nd  lateral  edges  of  the  sternum,  and  from  the  en.siibrm  car- 
tilage - 

I-N.  Into  the  posterior  surfaces  of  the  cartilages  of  tfce 
d,  fourth,  fifth  and  sixth  ribs. 


201 

DISSECTION 

OF  THE 

PARTS  WITHIN  THE  THORAX. 


When  the  muscles  are  removed  from  the  fore  part,  the 
sliest  will  appear  of  a  eonicle  shape,  for  each  rib  in  succession 
from  the  first,  forms  the  segment  of  a  larger  circle.  We 
shall  now  see  that  it  is  the  projection  of  the  bones  and  mus- 
cles of  the  shoulder,  which  gives  the  appearance  of  breadth 
to  the  upper  part  of  the  thorax  ;  and  this  view  will  also  ex- 
plain how  it  may  be  supposed  that  a'woimd  has  penetrated 
the  chest,  when  it  has  only  passed  under  the  shoulder. 

There  are  several  modes  of  opening  the  thorax.  The  fol- 
lowing method  will  be  found  useful,  when  we  wish  to  ac- 
quire a  general  idea  of  its  contents,  and  are  not  anxious  to 
preserve  the  bones  or  the  small  arteries. 

The  middle  of  the  cartilages  of  all  the  seven  superior  ribs, 
except  the  first,  are  to  be  cut  through  with  the  knife  ;*  tin- 
bony  parts  of  the  some  ribs  are  then  to  be  sawed  through  at 
a  point  near  to  their  angles,  taking  care  not  to  encroach  up- 
on any  of  the  muscles  of  the  back,  except  the  latissimus  dorsi. 

The  intermediate  portions  of  the  ribs  may  then  be  remov- 
ed ; — the  sternum  will  remain  supported  in  its  natural  posi- 
tion, by  its  union  to  the  first  rib  and  clavicle  above,  and  to 
the  remaining  ribs  below. 

We  shall  now  see  that  the  cavity  of  the  thorax  is  divided 
into  distinct  pares,  which  are  separated  from  each  other  by 
the  septum,  which  is  called  Mediastinum.  The  lungs  will  be 
seen  lying,  collapsed,  in  each  cavity  ;  but  this  is  not  the  sit- 
uation in  which  they  would  be,  in  a  state  of  health,  in  the 
living  body, — for,  as  there  is  then  a  complete  vacuum  in  thf 
chest,  the  lungs  would  be  distended  with  air,  so  as  to  fill  it 
accurately.  The  heart,  covered  with  its  pericardium,  will  be 
seen  protruding-  its  apex  to  the  left  side. 

If  there  has  been  no  disease  in  the  chest,  the  serous  mem- 
brane, which  is  called  Pleura,  and  which  covers  the  lungs, 
and  lines  the  inside  of  the  ribs  and  diaphragm,  will  appear  of 
a  glistening  colour.  It  is  difficult  for  a  student  who  studies 

*  We  shall  be  generally  obliged  to  use  a  saw,  to  cut 
through  the  cartilages  of  a  person  above  the  age  of  forty. 


202 

anatomy  from  books  only,  to  comprehend  the  folds  and  du- 
plicatures  of  this  membrane  ;  for  he  is  told,  that  it  forms  the 
Pleura  Pulmonalis,  Pleura  Costalis,  and  ^Mediastinum.  But, 
on  examination  of  the  body,  he  will  find,  that  these  terms  are 
used,  only  to  denote  the  several  portions  of  the  membrane. 
Perhaps  the  following  mode  of  tracing  the  pleura  will  be  ex- 
planatory of  its  folds,  <fec.  but  the  student  must  first  under- 
stand, that  there  is  a  distinct  pleura  in  each  cavity  of  the 
chest,  i.  e.  one  for  each  lung. 

This  membrane  may  be  considered  as  very  similar  to  the 
peritoneum ;  and  we  may  say,  here,  as  in  the  description  of 
the  relation  of  the  viscera  of  the  abdomen  to  the  peritoneum, 
that  the  viscera,  though  they  appear  to  be  within,  are  really 
external  to  the  membrane.  Taking  this,  then  for  granted, 
the  pleura  of  each  side  may  be  traced  in  the  following  man- 
ner : — If  we  pass  the  hand  through  the  opening  which  has 
been  made,  by  removing  the  ribs,  we  shall  feel  the  glistening 
surface  of  the  membrane,  covering  the  remaining  portions 
of  the  ribs  (this  part  of  the  membrane  is  called  Pleura  Costa- 
lis.) If  we  then  carry  the  finger  along  the  ribs  towards  the 
spine,  we  shall  feel  the  continuation  of  the  same  membrane  ; 
but  we  shall  not  be  able  to  pass  the  finger  farther  in  this  di- 
rection, because  the  membrane  is  here  connected  with  the 
root  of  the  lungs,  (forming  the  Ligament  of  the  Lungs^}  but 
if  we  pull  up  the  lungs,  we  may  see  the  membrane  passing 
from  the  root  to  the  upper  part, — whence  we  may  trace  it, 
over  the  surface,  down  into  the  fissures  between  the  lobes, 
and  at  last  to  the  opposite  part  of  the  root ;  this  portion  which 
is  continued  upon  the  lung,  is  called  Pleura  Pulmonalis.  If 
we  still  follow  the  membrane,  it  will  be  found  to  pass  up 
from  the  root  of  the  lungs,  over  the  pericardium,  to  the  ster- 
num. If  we  then  put  our  other  hand  into  the  opposite  side 
of  the  chest,  we  shall  feel  that  the  approximation  of  the  two 
pleurce  forms  a  septum  or  ^Mediastinum,  From  the  inside  of 
the  sternum,  the  membrane  may  be  traced  to  the  part  at 
which  we  commenced.  It  may  now  be  recollected,  that  this 
mode  of  tracing  the  membrane  is  nearly  similar  to  that  by 
which  the  peritoneum  was  traced  from  one  side  of  the  abdo- 
men to  the  other.  Therefore,  we  have  already  proved,  that 
the  lungs  are  as  much  external  to  the  pleura,  as  the  viscera 
of  the  abdomen  are  to  the  peritoneum.  The  analogy  also 
holds  good  in  regard  to  the  structure  of  the  two  membranes ; 
for  if  a  portion  of  the  pleura  be  torn  off,  its  external  surface? 
will  be  found  to  be  cellular,  while  its  internal  is  serous. 

Though,  in  reality,  there  is  nothing  difficult  to  compre- 
hend in  the  form  of  the  mediastinum,  still  students  are  often 
much  puzzled  by  it,  in  consequence  of  the  terms  anterior  and 


203 

posterior  mediastinum  being-  occasionally  used  to  denote  the 
anterior  and  posterior  cavities  of  the  mediastinum. 

This  confusion  between  the  terms,  has  arisen  in  conse- 
quence of  some  anatomists  having  divided  the  septum  into 
two  portions, — calling  that  part  which  is  anterior  to  the 
heart,  the  anterior  or  pectoral  mediastinum,  and  the  portion 
which  is  posterior  to  the  heart,  the  posterior  mediastinum. 

Though  there  is  good  authority  tor  describing  the  septum 
as  divisible  into  an  anterior  and  posterior  portion,  still  I  think 
that  the  anatomy  of  it,  will  be  more  intelligible  to  the  young 
student,  if  only  one  mediastinum  be  described,  between  the 
layers  of  which,  there  are  certain  spaces,  or,  if  we  will,  cam- 
ties. 

With  the  present  view  of  the  parts  before  us,  we  may  ea- 
sily comprehend  how  these  cavities  are  formed.  If  we  pass 
the  hand  into  each  side  of  the  chest,  we  shall  find  that  our 
fingers  will  nearly  meet,  about  three  inches'below  the  sternum ; 
but  not  above  that  point,  because  the  two  pleura  separate 
from  each  other  immediately  below  the  sternum  (the  space 
between  them  here,  has  been  called  the  Anterior  Cavity.) 
If  we  push  our  fingers  below  the  heart,  they  will  again 
nearly  meet ;  but  between  this  point  and  the  spine,  we  shall 
find  that  the  pleuree  do  not  come  into  close  contact,  so  that 
there  is  a  space  between  them  (which  is  called  the  posterior 
cavity.)  But  in  the  student's  anxiety  to  understand  these 
two  cavities,  he  is  apt  to  omit  the  most  important  of  all,  viz. 
the  middle  space,  or  cavity,  in  which  the  heart,  and  its  peri- 
cardium, are  situated. 

To  see  the  anterior  cavity,  we  must  cut  through  the  lower 
end  of  the  sternum,  and  carry  it  towards  the  neck  ;  in  doing 
this,  the  pleura  of  each  side  must  necessarily  be  separated 
from  each  other,  so  that  the  anterior  cavity  will  appear  lar- 
ger than  it  naturally  is.  The  parts  within  this  cavity,  or,  m 
other  words,  between  the  two  pleurse,  are  the  remains  of  the 
Tkymus  Gland,  and  some  small  vessels,  particularly  a  lym- 
phatic trunk,  which,  however,  is  not  visible  unless  it  be  in- 
jected. 

When  the  chest  is  cut  perpendicularly  through,  or  when 
the  diaphragm  is  dissected  away,  we  shall  see  the  Posterior 
Cavity, — which  is  formed  by  the  pleurae  separating  from  each 
other,  and  passing  to  the  sides  of  the  spine,  so  as  to  leave  u 
triangular  space, — through  which  the  oesophagus,  vena  azy- 
gos,  the  thoracic  duct,  par  vagum,  and  some  branches  of  the 
sympathetic,  will  afterwards  be  found  to  pass.  When  the 
upper  part  of  the  space  is  examined,  a  small  portion  of  the 
bronchii,  and  some  lymphatic  glands  will  be  found :  in  the 
lower  part  of  the  cavity,  we  may  perhaps  include  a  portion 


204 

of  the  vena  cava  ascondens ;  though  both  this,  and  the  cava 
descendens,  are  more  properly  in  the  middle  space.* 

If  we  now  examine  the  external  surface  of  the  pericardi- 
um, we  shall  find  that  a  considerable  part  of  it  is  covered  by 
the  pleura;  but  as  the  lower  part  of  the  pericardium  always 
adheres  strongly  to  the  tendinous  part  of  the  diaphragm,  nei- 
ther this  portion  of  it,  nor  of  the  diaphragm,  can  be  lined  by 
the  pleura. 

When  we  open  the  pericardium,  we  shall  find  that  its  in- 
ternal surface  is  exactly  similar  to  that  of  the  pleura, — in- 
deed this  membrane  may  be  taken  as  an  example  of  the  great 
serous  membranes  ;  for  its  connections  with  the  heart,  are 
the  same  as  those  of  the  peritoneum  with  the  viscera  of  tiie 
abdomen,  or  of  the  pleura  with  the  lungs.  There  has  been 
a  homely  simile  often  given  as  explanatory  of  the  connec- 
tion between  the  pericardium  and  heart,  viz.  the  double 
night-cap  on  the  head  ;  but  there  is  no  necessity  for  such  an 
analogy ;  for,  by  holding  the  bag  of  the  pericardium  open, 
we  may  trace  the  loose  portion  down  to  wards  the  base  of  the 
heart,  where  the  great  vessels  arise  ;  from  this,  it  is  reflect- 
ed upon  the  anterior  surface  of  the  heart,  to  which  it  ad- 
heres very  closely  ;  if  we  trace  it  to  the  opposite  side,  we 
shall  find  it  again  reflected  from  the  base,  to  form  the  bag. 

We  may  now  examine  the  general  appearance  of  the  ex- 
ternal parts  of  the  heart. 

If  the  pericardium  has  been  slit  open  on  the  fore  part,  the 
Ventricle  which  is  called  the  Right,  though,  from  its  position 
we  should  be  more  inclined  to  call  it  the  Anterior,  will  be  the 
first  part  seen.  The  Right  Auricle  will  probably  be  so  dis- 
tended with  blood,  as  to  project,  even  more  than  the  right 
ventricle.  The  Left  Ventricle  will  not  be  seen :  but  by  ta- 
king the  heart  in  the  hand,  it  will  be  at  once  distinguished, 
on  the  posterior  part,  by  its  firm  fleshy  consistence  ;  for  the 
right  is  comparatively  loose  in  its  texture,  and  feels  as  if 
wrapped  round  the  left.  The  top  of  the  Left  Auricle  will  be 
seen  lapping  round  upon  the  upper  part  of  the  left  ventricle; 
and  from  below  it,  a  branch  of  the  coronary  artery,  and  of  the 
coronary  vein,  may  be  traced  towards  the  Apex  of  the  heart. 
These  vessels  mark  the  division  of  the  heart  into  the  two 
ventricles,  as  they  run  nearly  parallel,  but  a  little  to  the  left, 
of  the  Septum  Cordis. 

By  cutting  away  the  loose  portions  of  the  pericardium,  we 
may  show  several  of  the  great  vessels  of  the  heart.  The 
Vena  Cava  Superior  will  be  most  distinctly  seen,  because  it 

*  Though  these  parts  have  been  now  described,  it  will  be 
inconvenient  to  follow  them  in  the  first  dissection. 


205 

f 

is  generally  distended  with  blood.  Only  a  very  small  por- 
tionof  the  Inferwr  Cava  can  be  shown,  as  the  lower  part  of 
the  right  auricle  is  nearly  in  contact  with  the  diaphragm. — 
The  vessel  which  arises  from  the  right  ventricle,  is  the  Pul- 
monary Artery  :  but  very  little  more  than  the  origin  of  tliis, 
can  be  seen,  as  it  is  covered  by  a  portion  of  the  Arch,  of  the 
Aorta.  We  cannot  see  the  origin  of  the  aorta  at  present,  as 
it  rises  from  the  posterior  part  of  the  heart ;  nor  are  the  Put- 
monary  I^eitis  visible  in  this  view,  as  they  are  also  situated  on 
the  back  part. 

Before  the  hoart  and  great  vessels  are  cut  out,  We  should 
take  a  general  view  of  die  lungs.  If  there  be  no  preternatu- 
ral adhesions  of  the  lungs  to  the  pleura,  where  it  lines  the 
ribs,  their  general  figure  will  be  easily  understood.  It  will 
bo  seen  that  the  base  of  the  lungs,  or  where  they  rest  upon 
the  diaphragm,  is  concave,  answering  to  the  convexity  of  the 
diaphragm;  that  they  reach  far  behind  the  anterior  part  of 
the  diaphragm  ;  and  that  they  are  pyramidial  towards  the 
upper  part  of  the  chest,  answering  to  the  pyramidial  shape  of 
the-.thorux. 

We  shall  see  that  the  lungs  of  each  side  are  subdivided  in- 
to lobes.  Those  of  the  right  side,  generally  into  three, — 
two  greater  ones,  and  an  intermediate  lesser  lobe  ;  and  the 
left,  into  two  lobes.  This,  however,  is  sometimes  reversed. 
The  lobes  are  again  divided  into  groups  of  cells  ;  and  these 
again,  into  a  series  of  smaller  vesicles,  into  'which  air  is  ad- 
mitted, by  the  minute  and  less  rigid  branches  of  the  bronchii. 

The  lungs  are  generally  of  a  reddish  colour  in  children, — 
grey  in  adults,  arid  whitish  in  old  age. 

We  shall  find  it  advantageous  to  examine  the  minute 
structure  of  the  lungs  in  the  sheep  or  ox,— because  it  is  es- 
sentially the  same  as  in  man.  The  lungs  of  those  animals 
can  be  at  any  time  procured  in  a  healthy  state,  while  in  the 
greater  number  of  bodies,  which  we  examine  in  the  dissec^ 
thig- room,  the  lungs  are  more  or  less  diseased.  The  bron- 
chii may  be  traced  to  their  terminations  in  the  air  cells,  up- 
on which  the  branches  of  the  pulmonary  arteries  and  veins 
are  distributed.  But  it  is  in  the  turtle  tribe,  particularly, 
that  we  shall  see  the  air  cells,  for  in  these,  they  are  particu- 
larly large  ;  they  will  be  most  distinctly  demonstrated,  b^ 
distending  a  portion  of  the  lung  with  air,  and  by  making  va^ 
rious  sections  of  it.  when  it  is  dried. 

As  the  larynx  and  oesophagus  have  already  been  cut 
through,  the  heart  and  lungs  may  now  be  easily  removed 
from  the  chest,  by  pulling  them,  with  their  vessels,  &c.  from 
their  connections  to  the  spine,  as  far  as  to  the  diaphragm ; 
and  as  the  examination  of  the  viscera  of  the  abdomen  will 
S 


206 

probably  be  finished  ere  this  time,  a  part  of  the  diaphragm 
may  be  cut  out  along  with  the  heart. 

I  shall  now  give  only  such  a  description  of  the  manner  of 
examining  the  heart,  as  will  enable  the  dissector  to  follow 
the  examination  of  the  minute  anatomy  of  it,  in  his  second 
dissection.* 

When  the  heart  is  laid  with  the  apex  uppermost,  the  lungs 
will  so  fall  from  it,  that  the  ventricles  and  vessels  will  be 
more  distinctly  seen,  than  when  the  heart  was  in  connection 
with  the  other  parts  of  the  body.  But  when  the  base  of  the 
heart  is  turned  up,  the  parts  will  appear  very  confused,  be- 
cause, not  only  the  bronchi! ,  or  divisions  of  The  trachea  which 
pass  into  the  lungs,  will  be  now  presented, — but  also,  the 
•ftorta  and  cBSOphagus  will  be  seen  adhering  to  the  heart. 
The  oesophagus  should  be  entirely  removed,  and  also 
a  considerable  portion  of  the  aorta;  the  divisions  of  the 
trachea  should  then  be  traced  into  the  lungs  :  and  in  doing 
this,  we  shnll  see  that  the  right  portion,  or  bronchus,  divides 
into  three  branches,  corresponding  to  the  three  lobes., — 
while  the  left  is  divided  only  into  two.  By  now  removing 
the  remaining  part  of  the  pericardium,  the  brunches  of  the 
pulmonary  artery  will  be  seen,  and  the  pulmonary  veins  may 
be  traced  into  the  left  auricle. 

The  lungs  «anay  then  be  separated  from  the  heart,  by  cut- 
ting through  the  four  or  Jive  pulmonary  veins,  and  the  branch 
es  of  the  pulmonary  artery. 

We  may  now  examine  the  interior  of  the  heart,  following, 
in  our  dissection,  the  course  by  which  the  blood  passes  through 
the  heart. 

We  should  pass  a  probe,  or  the  handle  of  a  knife,  from  the 
inferior  to  the  superior  cava  ;  and  then  lay  open  the  vessels, 
and  the  cavity,  in  the  line  of  the  probe :  this  will  show  the 
meeting  of  the  great  veins  which  form  that  part  of  the  auri- 
cle that  is  called  sinus, — to  the  lateral  part  of  which,  the  por- 
tion proper!)^  called  auricle,  will  be  seen.  This  latter  part  is 
to  be  opened  by  the  scissors,  and  then  the  muscular  bands 
which  are  called  Jdusculi  Pcctinati,  will  be  seen. 

With  this  view  before  us,  we  cannot  avoid  seeing  the  open- 
ing into  the  ventricle,  which  is  called  Odeum  t'tnoswn  ;  if 
we  push  our  ringer  into  this  opening,  we  shall  feel  the  rough 
inner  surface  of  the  right  ventricle.  To  open  this  ventricle, 
we  should  push  the  finger  as  far  down  as  we  can,  and  cut  up- 
on it ;  the  opening  may  be  enlarged,  by  cutting  in  a  direction 
towards  the  pulmonary  artery.  If  this  does  not  give  suffi- 
cient room  for  seeing  the  parts  within  the  ventricle,  a  por- 

*  The  heart  and  the  great  vessels  should  be  completely 
cleared  of  their  blood,  by  washing  them  in  water. 


•207 

tion  may  be  cut  out.  The  first  thing  we  shall  notice,  is,  that 
the  interior  of  the  ventricle  is  very  irregular,  in  consequence 
of  a  number  of  muscular  bauds  running  across  it,  and  which 
are  called  Column-ece  Carnece.  We  may  observe  that  they 
are  more  numerous  towards  the  osteum  venosum,  than  to- 
wards the  pulmonary  artery ;  and  when  we  examine  the  os- 
teum venosum  more  minutely,  we  shall  find  that  there  is  a 
get  of  these  fleshy  columns  united  with  tendinous  bands  (Car- 
dec  Tendimv)  which  expand  into  a  membrane  that  is  connected 
with  the  orifice.  This  structure  forms  a  sort  of  valve ;  for 
when  the  ventricle  contracts  to  push  the  blood  into  the  pul- 
monary artery,  these  cords  will  be  pulled  so  tight,  as  to  pre- 
vent the  blood  from  passing  back  into  the  auricle.  As  this 
apparatus  is  formed  of  three  distinct  sets  of  columnece  car- 
nee?,  and  cordce  tendinece,  it  is  called  the  Tricusjrid  Valve. 

We  may  now  lay  open  the  pulmonary  artery,  and  we  shall 
find  that  are  three  distinct  Valves  at  its  root,  which,  from 
their  shape,  are  called  Semilunar.  As  these  valves  must  be 
thrown  down  when  the  vessel  contracts  upon  the  blood  which 
is  propelled  into  it  by  the  ventricle,  there  can  be  little  doubt, 
that  their  use  is,  to  prevent  the  blood  from  regurgitating  in- 
to the  ventricle,  when  it  relaxes  to  receive  the  blood  which 
is  pushed  into  it  from  the  auricle  by  the  action  of  the  muscu- 
li  pectinati. 

As  the  lungs  have  been  cut  away,  we  must  (following  the 
course  of  the  circulation)  pass  to  the  examination  of  the  left 
side  of  the  heart. 

The  left  auricle  is  to  be  opened  by  cutting  upon  a  probe 
which  has  beerv  passed  into  it,  from  one  of  the  pulmonary 
veins.  When  it  is  fully  opened,  the  same  general  appear- 
ances will  baleen,  as  in  the  right  ;  the  finger  is  then  to  be 
passed  into  the  opening  into  the  left  ventricle,  which  is  cal- 
'  led  Oxteum  J±nteri<mnn ;  the  cavity  of  the  ventricle  is  then  to 
be  opened  by  following  the  rules  which  were  prescribed  for 
opening  the  right  side. 

Every  part  in  this  ventricle  will  be  found  essentially  the 
same  as  in  the  right, — the  only  difference  in  the  two  ventri- 
cles, being,  that  all  the  parts  in  the  left,  are  much  stronger 
than  in  the  right :  the  reason  of  this,  would  appear  to  be, 
that  the  blood  is  to  be  farther  propelled  by  the  left  than  by 
the  rio-lit.  As  there  are  only  two  sets  of  columns  and  cords 
to  form  the  valve  between  the  left  auricle  and  left  ventricle, 
and  as  they  have  some  resemblance  to  a  bishop's  mitre,  the 
valve  has  been  called  the  Mitral  Valve.  The  valves  at  the 
root  of  the  aorta  have  certain  little  eminences  in  their  cen- 
tres, more,  distinct  than  those  of  the  pulmonory  artery. — 


208 

These  bodies  are,  in  both  arteries,   generally  called  Corpora 
Sesamoidea. 

I  shall  now  describe  the  manner  of  showing  the  more  mi- 
nute structure  of  the  heart.  But  I  would  not  advise  the 
young  student  to  attend  particularly  to  this,  in  his  first  dis- 
section 

The  student  may,  at  any  time,  have  an  opportunity  of  ex- 
amining the  minute  structure  of  the  heart. ;  as  the  form  of 
the  hearts  of  quadrupeds,  and  of  the  greater  number  of  warm 
blooded  animals,  is,  in  all  essential  points^  the  same  as  that  of 
the  human  body. 

We  shall  find,  by  the  names  which  are  given  to  the  diffe- 
rent parts  of  the  heart,  that  the  older  anatomists  took  ad- 
vantage of  this;  for  many  of  the  terms  will  be  much  more 
readily  understood  by  dissecting  the  heart  of  a  sheep,  or  of 
an  ox,  than  by  examining  such  hearts  as  are  generally  found 
in  those  bodies  which  are  brought  into  the  dissecting-room. 

We  shall  also  derive  much  assistance  in.  our  examination 
of  the  structure  of  the  heart-  as  the  principal  agent  in  the  cir- 
culation of  the  blood,  by  dissecting  the  hearts  of  the  various 
classes  of  animals  r  for  then  we  shall  understand,  that  the 
structure  of  the  heart  varies  according  to  the  different  sys- 
tems of  respiration, 

The  method  which  has  been  described  for  making  the  first 
dissection  of  tine  heart,  may  be  nearly  followed  in  making  a 
more  minute  examination  of  it.  In  removing  the  heart  from 
the  body,  we  should  always  take  a  small  portion  of  the  dia- 
phragm with  the  inferior  cava ;  and  in  opening  the  cavities, 
.a  little  more  attention  should  be  paid  to  certain  marks. 

To  open  the  auricle,  we  should  introduce  a  probe,  or  blow- 
pipe, into  the  lower  cava,  and  convey  its  point  to  the  project- 
ing part  of  the  auricle.  If  we  now  cut  the  auricle  in  the  di- 
rection of  the  probe,  the  Eustachian  valve,  and  every  impor- 
tant part,  will  be  avoided.  Continuing  to  hold  the  heart 
nearly  in  the  same  situation  in  which  it  lies  when  in  the  bo- 
dy, the  septum  which  divides  the  right  from  the  left  auricle, 
will  be  seen, — and  upon  it,  the  remains  of  the  Foramen  Omit.. 
This  fossa  ovalis  is  an  irrregular  depression,  of  an  oval  form, 
with  its  border,  especially  on  its  upper  part,  elevated  into  a 
ring.  Its  margin  is  white,  and  has  somewhat  the  appearance  of 
tendon.  The  part  in  the  middle,  which  performed  the  office  of 
a  valve  in  the  foetus,  is  white  and  firm.  This  membranous 
portion  seems  continuous  with  the  margin  upon  the  lower 
part,— while,  upon  the  upper  part,  it  goes  behind  the  margin 
of  the  fossa. 

If  the  lower  cava,  where  it  expands  into  the  auricle,  be 
held  open,'  a  membrane  will  be  seen  stretching  from  the  in 


200 

aer  side  of  the  margin  of  the  foramen  ovate,  (this  portion  is 
sometimes  called  the  iMhtmi-s  of  the  foramen  ovale)  round  up- 
on the  half  of  the  root  of  the  vein  nearest  to  the  opening  of 
the  auricle  into  the  ventric'e:  this  is  the  Eu-stachian  Valve  : 
it  is  like  a  duplicature  of  the  inner  membrane  of  the  auricle. 

Behind  the  Eustechian  valve,  is  the  opening  of  the  great 
coronary  vein ;  which  vein,  running  round  the  margin  of  the 
left  auricle,  gathers  the  blood  from  the  smaller  coronary 
veins.  The  little  semih/nnr  valve,  on  the  mouth  of  this  vein. 
was  likewise  first  described  by  Eustachius.  Some  small 
openings,  of  a  size  sufficient  to  admit  bristles,  may  be  found 
m  different  parts  of  the  auricle.  They  were  at  one  time  sup- 
posed to  be  ducts,  and  were  called  foramina  Thebesii;  but 
they  are  probably  only  the  openings  of  some  of  the.  small 
veins  of  the  heart,  into  the  auricle. 

The  only  other  part  which  we  have  to  observe  in  the  au- 
ricle, besides  the  miiseufapectinatL  which  was  not  seen  in  the 
first  general  dissection,  is  the  Tubercle  of  Lower.  But  this 
is  one  of  those  parts,  the  description  of  which  has  been  taken 
from  the  heart  of  the  lower  animals.  It  is  nothing  more 
than  an  eminence,  which  is  formed  by  a  portion  of  firm  fat, 
which,  in  a  healthy  heart,  is  situated  immediately  at  the  an- 
gle where  the  two  venae  cavse  unite,  to  form  the  great  sinews 
of  the  auricle. 

The  right  ventricle  is  now  to  be  opened,  by  making  an  in- 
cision from  the  root  of  the  pulmonary  artery  to  the  apex  of 
the  heart,  and  parallel  with  the  right  branch  of  the  left  coro- 
nary artery,  but  a  little  to  the  right  of  it.  By  an  incision: 
ma'iein  this  direction,  (care  being  taken  to  carry  it  no  deep- 
er than  the  thin  sides  of  the  ventricle,)  none  of  the  columr.ae 
ear  nee  will  be  cut  ;  for  the  ventricle  will  be  opened  exactly 
to  one  side  of  the  septum  of  the  heart.  The  incision  may 
be  continued  round  the  b?pe  of  the  heart,  by  the  root  of  the 
pulmcnic  artery  and  margin  of  the  right  auricle;  or,  the  first 
incision  may  be  continued  round  the  point  or  apex  cf  the 
heart,  so  a-s  to  lay  the  ventricle  open,  as  if  it  were  cleft  or 
split  from  the  apex. 

OF  THE  PARTS  SEEN  UPON  OPFNTNG  THE  RIGHT  VENTRI- 
CLE.— First,  an  irregular  column  of  flesh  is  seen  rising  from 
that  part  of  the  ventricle  which  is  laid  back,  and  dividing  in- 
to seven  or  eight  delicate  cor  OCR  tendinese,  which  are  expand- 
ed into  a  broad  tendon  that  forms  the  anterior  division  of  the 
trkuspid  valve.  From  a  little  mamillary  process  of  flesh, 
near  the  valves  of  the  pulmonic  artery,  and  where  the  sur- 
face of  the  ventricle  is  smooth,  there  is  sent  out,  in  three  di- 
divfpns,  a  great  number  of  delicate  ccrdae  tendir.se,  which 
are  also  connected  with  the  anterior  division  of  the  valves 


8 '4 


210 

The  next  division  of  the  origins  of  the  cordae  tendineaj,  i> 
from  the  septum  of  the  two  ventricles  ;  from  which  they 
arise  by  separate  pillars.  And  again,  from  the  back  part  of  the 
ventricle,  there  is  a  strong  column,  having  a  double  origin 
from  the  two  opposite  sides  of  the  ventricle,  and  to  which  the 
great  posterior  division  of  the  membraneous  valve  is  attach- 
ed. By  the  attachment  of  these  three  divisions  to  the  ten- 
dinous circle  which  surrounds  the  opening  between  the  auri- 
cle and  ventricle,  the  tricuspid  valve  is  formed. 

The  smoothness  of  the  ventricle  towards  the  opening  in- 
to the  pulmonic  artery,  maybe  observed.  When  the  pulmo- 
nic  artery  is  slit  up,  its  three  semilunar  valves  will  be  seen. 
These  valves  are  more  frequently  perforated  in  the  edges. 
than  -those  of  the  aorta. 


Ox    OPKMISG     THE     I.F.FT  SIDE  OF    THE  HEART.  - 

the  blade  of  the  scissors  into  one  of  the  pulnionic  veins,  and,. 
insinuating  it  into  the  part  of  the  auricle  which  projects  by 
the  sides  of  the  pulmonic  artery,  slit  it  up.  There  is  little  to 
be  observed  in  this  auricle  :  the  JiJusculi  fectinati  not  so 
strong,  nor  so  evident  upon  its  inside.,  as  those  of  the  right 
auricle.  The  Puhnonic  Veins  pass  almost  always  into  the 
cavity  by  four  openings  ;•  those  from  the  right  lung  are  closer 
together  than  the  left  branches. 

To  expose  the  left  ventricle,  make  an  incision  as  far  to- 
wards >he  left  side  of  the  artery  and  vein  which  rundown 
from  the  left  auricle  towards  the  apex-  as  the  incision  made 
to  lay  open  the  right  ventricle  was  to  the  right  of  these  ves- 
sels. In  opening  this  ventricle,  there  is  less  fear  of  cutting 
upon  the  columns;  carnete,  or  upon  the  septum  ;  fur,  as  the 
right  ventricle  is  open,  the  septum  can  be  seen,,  and  we  can 
cut  immediately  on  the  other  side  of  it  ;  while  the  columns? 
are  collected  in  the  further  side-  of  the  ventricle,  round  the 
opening  of  the  auricle,  and  are  not  much  exposed  to  the 
knife.  Continuing  the  upper  part  of  the  incision  round  un- 
der the  projecting  auricle,  slit  up  the  aorta,  to  show  its 
valves  :  in  doing  which,  that  branch  of  the  left  coronary  ar- 
tery which  comes  out  under  the  margin  of  the  left  auricle, 
must  be  cut  through.  When  this  ventricle  is  laid  open,  that 
part  which  id  towards  the  septum,  and  more  particularly  near 
the  artery,  wrill  not  appear  rugged  with  the  interlacements 
of  the  columns  carnese,  or  lacerti,  as  they  are  sometimes  cal- 
ed.  The  columns  which  are  connected  with  the  mitral 
valve,  are  thick  and  short,  and  confined  in  a  corner  of  the 
ventricle  ;  nor  do  they  spread  their  roots  so  extensively  as 
those  of  the  right  ventricle. 

Turning  our  attention  to  the?  semilunar,  or  sigmoid  valves 
we  may  observe,  in  the  child,,  that  they  arc 


211 

loosely  floating1  membranes,  variegated  in  part  by  a  \\ 
opacity ;  while  their  edges  are  at  some  places  so  transpa- 
rent,  that  there  appears  often  be  deficiencies  of  the  valve 
near  the  edge,  when  there  are  none.  There  are,  however, 
such  deficiencies  sometimes.  In  the  adult,  these  valves  ac- 
quire greater  firmness  and  strength,  and  are  opaque  ;  and 
there  is  always  on  the  middle  of  each  valve,  a  little  body. 
Vv'hich  is  called  Corpus  Sesamoideum,  or  Corpus  Aurantii. — 
Behind  each  of  these  valves  are  seen  the  Lesser  Sinuses  of 
fie  Aorta,  or,  as  they  are  sometimes  called,  Sinuses  ofjlfor- 
gagni ;  here  the  coronary  arteries  will  be  seen  to  arise. 

When  the  heart  of  the  foetus  is  examined,  we  shall  find  that 
it  differs  very  essentially  from  that  of  the  adult.  If  we  lay  open 
the  two  auricles,  we  shall  see  an  oval  hole  (Foramen  Ovale) 
in  the  septum,  which  in  the  adult  separates  the  one  auricle 
from  the  other.  The  ventricles  are  nearly  the  same  as  in 
the  adult  ;  but  from  the  pulmonary  artery,  a  very  large  ves- 
sel passes  directly  to  the  aorta.  This  vessel  is  called  Ductus 
Jirteriosus.  In  the  adult,  it  is  found  degenerated  into  a  lig- 
ament, which  is  called  the  remains  of  the  ductus  arteriosus. 

The  minute  structure  of  the  walls  of  the  ventricles  maybe 
more  easily  shown,  by  plunging  the  heart  into  boiling  water, 
for  then  v/e  may  easily  strip  off  the  pericardium  from  the  sur- 
face, so  as  to  exhibit  the  different  orders  of  muscular  fibres 
which  compose  it. 

Part  of  the  aorta  should  be  kept  for  the  examination  of  the 
coats  of  an  artery.  About  an  inch  of  it  may  be  distended 
with  a  piece  of  candle  or  bougie, — and  another  portion  may 
be  laid  open  :  in  the  distended  portion  we  may  show  the 
coats,  beginning  a.t  the  external, — in  the  other  portion,  the 
internal  may  be  shown  first. 

There  are  generally  only  three  coats  described  in  an  arte- 
ry,— but  we  may  enumerate  a  fourth,  by  calling  the  cellular 
membrane  which  is  between  the  muscular  and  internal  coat, 
a  distinct  one. 

The  three  proper  coats  are, — the  first  Cellular,  Vascular, 
or  Tendinous  Coat ;  the  next  is  the  J\Juscular  Coat ;  and  the 
third  the  Internal. 

The  outer  cellular  coat  of  an  artery  may  be  separated  into 
many  layers  ;  easily  into  three  layers.  These  layers  are 
gradually,  as  they  proceed  inwards,  changed  in  their  nature 
from  that  of  the  general  investing  cellular  membrane  by 
which  the  vessel  is  connected  to  the  parts  with  which  it  is  in 
Contact;  they  are  at  least  incorporated  into  a  more  regular 
'•oat,  whence  this  has  been  called  the  tendinous  coat  ;  for  it  is 
dense,  white  and  elastic,  and  has  much  more  toughness  than 
the  inner  .coats ;  but  while  the  inner  surface  of  this,  layer,  viz* 


212 

that  which  is  contiguous  to  the  muscular  coat,  is  more  accu- 
rately defined,  its  outer  surface  seeming  imperceptibly  to  de- 
generate into  the  nature  of  cellular  substance — whence  it 
has  been  described  as  a  cellular  cwtt ;  but  it  ha£  also  been 
called  the  vascular  coat,  because  the  email  arteries  which 
ramify  upon  the  larger  trunks  of  arteries,  (the  Vam  Traso- 
rum,)  run  chiefly  in  it.  These  arteries  are  not,  in  general, 
der  ved  from  the  large  vessels  on  which  they  lie,  but  come 
from  some  of  the  smaller  branches  of  arteries.  They  are,  to 
the  great  arteries,  what  the  coronary  arteries  are  to  the 
heart.  They  supply  and  nourish  the  coats  of  the  arteries  , 
while  the  column  of  blood  in  their  cavities  seems  to  have  no 
such  effect.  To  prepare  these  subordinate  vessels,  they 
must  be  injected  minutely  (before  the  artery  is  removed  from 
the  body)  with  size,  or  fine  varnish  injection,  of  a  light  cole  ur, 
or  of  pure  white.  If,  after  this  minute  injection,  a  cc  arser 
and  dark  coloured  injection  be  thrown  into  the  trunks,  the 
light  coloured  and  fine  injection  will  be  pushed  onward, 
while  the  coarse  injection  fills  only  the  trunks  ;  making-  thus 
a  contrast  between  the  lavge  vessels  and  the  ramifications  of 
the  vasa  vasorum,  upcn  its  surface.  The  artery,  when  thus 
injected  and  prepared,  may  be.  dried  and  varnished,  or  pre- 
serv  ed  in  spirits. 

THF,  MUSCULAR  COAT. — Raving  dissected  these  cuter 
layers,  the  muscular  coat  appears.  Its  fibres  run  in  circles 
round  the  artery  ; —  no  fibres  run  in  tfce  length  cf  the  artery. 
The  circular  fibres  of  the  muscular  coat  do  not  all  pass  rcund 
die  artery.  On  attempting  to  trace  any  single  fibre,  it  may 
be  found  to  make  a  complete  circle  round  the  artery  ;  but, 
on  further  examination,  the  circle  w<ill  be  found  to  be  made 
up  of  segments  of  fibres,  irregularly  combined,  the  extremi- 
ties of  which  are  intermixed,  and  seem  lost  among  each  eth- 
er. When  the  arteries  of  a  young  body  are  examined,  the 
muscularity  cfthe  vessel  will  be  more  observable  in  the  arte- 
ries of  the  thigh.  In  an  old  body,  the  muscular  coat  may  be 
divided  into  three  or  four  lamirse. 

Immediately  under  the  muscular  coat,  there  is  a  little  cel- 
lular membrane,  which  has  been  sometimes  called  the  inner- 
cellular  root, — but  it  is  hardly  worthy  of  this  term. 

The  internal  coat  is  mrst  easily  demonstrated  by  merely 
laying  the  artery  open.  It  is  very  -difficult,  unless  the  arte- 
ry be  diseased,  to  separate  this  from  the  other  coats.. 


213 


MANNER  OF  EXAMINING  THE  PARTS  IN  Tlffi 
THORAX,  TO  DISCOVER  THE  SEAT  OP  DIS- 
EASE. 

The  common  method  of  opening*  the  chest,  for  the  purpose 
of  examining  the  state  of  the  viscera,  is,  to  make  a  longitu- 
dinal incision  through  the  integuments, — to  dissect  them  and 
the  muscles  towards*the  sides, — and  then  to  cut  through  the 
cartilages  of  the  ribs,  and  remove  the  sternum.  This  meth- 
od has  certainly  the  advantage  of  making  the  view  of  the 
parts  within,  more  distinct ;  but  it  is  very  difficult  to  sew  the 
body  up  afterwards,  so  as  to  prevent  it  from  appearing  much 
disfigured.  Unless  the  patient  be  supposed  to  have  died  of 
aneurism,  or  some  very  particular  disease,  the  following  me- 
thod will  be  found  to  allow  of  sufficient  room  for  examining 
the  lungs  and  heart ;  and  when  the  examination  is  finished, 
the  parts  may  be  put  together  without  the  body  being  at  all 
disfigured. 

Make  an  incision  from  opposite  the  cricoid  cartilage  to  the 
umbilicus  (if  the  abdomen  is  to  be  examined,  the  incision 
may  be  prolonged  to  the  pubes,)  and  saw  through  the  middle 
of  the  sternum.  The  portions  of  the  sternum  are  then  to  be 
forcibly  separated  from  each  other,  and  a  piece  of  wood  is  to- 
be  placed  between  them. — To  do  this,  a  considerable  force  is 
necessary,  for  the  parts  must  be  pulled  asunder  until  the  ribs 
give  way  at  their  angles; — it  will  be  most  easily  done  by  two 
persons  taking  hold  of  the  sides  of  the  sternum,  and  pulling 
against  each  other:  their  hands  should  be  guarded  by  putting- 
a  cloth  between  them  and  the  cut  portion  of  the  sternum. 

The  first  part  which  we  should  examine,  is  the  pleura.  As 
it  is  a  serous  membrane,  there  will  always  be  a  certain  quan- 
tity  of  fluid  within  it ; — in  the  healthy  state,  there  is  only  as 
much  rluid  as  will  moisten  the  surface  of  the  membrane  :  but 
when  there  has  been  a  general  state  of  weaknesss,  the  fluid 
will  be  thrown  out  in  greater  quantity  than  the  absorbents 
can  take  up,  and  then  the  disease  called  hydrothorax  will  be 
formed.  In  such  a  case,  we  shall  occasionally  find  more 
than  three  quarts  of  water  within  the  pleura.  When  there 
is  a-m*  /m/  in  other  parts  of  the  body,  a  certain  quantity  of 
fluid  will  be  found  in  the  chest. — It  is  also  a  very  common 
appearance  in  the  greater  number  of  those  who  have  Buffer- 
e  1  from  protracted  disease  of  the  viscera,  or  in  children  who 
have  died  in  consequence  of  measles.  The  cases  which  have 
occurred  in  the  cancer  ward  of  the  Middlesex  Hospital,  have 
been  sufficiently  numerous,  to  prove,  that  this  effusion  is^the 
i nost  common  cause  of  the  death  of  those  who  suffer  from 


214 

Cancer  of  the  breast.  It  is  also  important  to  know,  that  this, 
and  a  slight  degree  of  inflammation,  are  very  frequently  the* 
cause  of  death  in  those  who  have  met  with  severe  accidents, 
or  who  have  undergone  a  great  operation. — This  is  so  impor- 
tant a  point  in  the  practice  of  surgery,  that  1  shall  refer  the 
student  to  a  paper  which  he  will  find  upon  the  subject,  in  the 
Surgical  Observations,  by  Mr.  Bell. 

The  pleura  is  very  subject  to  inflammation.  In  the  case 
of  common  phthisis,  it  will  be  found  so  thickened,  and  its 
sraooth  serous  surface  will  be  so  altered  in  structure,  that  it 
will  be  hardly  possible  to  recognize  it.  This  may  be  consid- 
ered as  a  chronic  state  of  the  inflammation;  but  if  a  patient 
dies  of  pneumonia,  within  a  week  after  the  first  attack,  a 
quantity  of  coagula.ble  lymph,  or  inflammatory  crust,  will  be 
seen  upon  the  inner  surface  of  the  chest,  and  from  which  it 
may  be  torn,  as  a  tremulous  gelatinous  layer ;  or,  upon  the 
surface  of  the  lungs,  a  jelly  will  be  thrown  out,  which  can  be 
wiped  away  with  a  cloth.  These  exudations  approach,  in 
their  more  advanced  stages,  to  the  appearance  of  the  natural 
membranes,  and  can  with  difficulty  be  distinguished  frc  m  the 
original  membranes.  When  there  is  a  vacancy  in  the  thorax, 
from  disease,  as  from  the  destruction  of  the  lungs  of  one  side, 
and  when  pus  has  been  formed,  there  will  generally  be  layers 
of  coagulable  lymph  upon  the  inner  surface  of  the  pleura;  or, 
we  shall  find  a  serous  fluid  in  the  bottom  of  the  chest,  with 
flakes  of  the  coagulable  lymph,  like  membranes,  flcatiug 
in  it. 

When  the  pus  is  in  great  quantity,  the  disease  is  then  call- 
ed em-pyema  ;  and  this  will  also  sometimes  be  found  after  in- 
juries by  falls.  The  vomica  is  the  name  given  to  an  abscess 
in  the  lung;  but  if  this  bursts  into  the  cavity  of  the  chest,  it 
will  form  the  empyema :  this,  however,  is  not  the  species  of 
this  disease,  for  which  we  would  propose  the  operation  of 
paracentesis  thoracic. 

OF  ADHESIONS  OF  THE  LUNGS. — Adhesions  of  the  lungs 
to  the  pleura,  where  it  lines  the  ribs,  or  where  it  covers  the 
pericardium,  are  so  frequent,  that  they  need  scarcely  be  con- 
sidered as  a  disease, — at  least,  they  are  of  no  account  in  in- 
vestigating the  cause  of  death;  for  it  would  appear,  that  the 
slightest  inflammation,  during  any  period  of  the  person's  life, 
even  from  colds,  which  pass  unobserved,  produces  adhesions, 
which  are  never  afterwards  removed. 

In  examining  the  state  of  the  lungs ,  it  is  of  much  impor- 
tance to  distinguish  between  the  effect  of  the  gravitation  of 
the  blood,  and  the  consequence  of  previous  inflammation. 
From  the  body's  lying  in  a  horizontal  posture  after  death, 
hload  is  often  accumulated  at  the  posterior  part  of  the  lur^ 


215 

them  there  a  deeper  colour  and  rendering  them  hea- 
vier. In  this  case,  there  will  be  found  no  crowd  of  fine  ves- 
sels filled  with  blood,  nor  any  other  mark  of  inflammation  of 
the  pleura.  Where  blood  is  accumulated  in  any  part  of  a 
lung,  after  death,  from  gravitation,  it  is  always  of  a  dark 
colour  ;  but  where  blood  is  accumulated  from  inflammation, 
-the  part  will  appear  florid.  The  lung  which  is  loaded  with 
blood,  from  gravitation,  may  be  distinguished  from  that 
which  is  condensed  by  inflammation,  by  cutting  into  it ;  for 
then,  the  blood  may  be  squeezed  out,  and  the  lung  will  re- 
gain its  natural  appearance ; — but  a  disease*!  portion  will  feel 
denser  and  heavier,  and  when  squeezed,  the  blood  will  not 
escape,  nor  will  there  be  any  of  that  crackling  feel,  which  is 
felt  in  the  healthy  structure ;  and  the  interior  of  the  sub- 
stance, when  it  is  cut  into,  will  have  much  resemblance  to 
the  liver, — whence  it  has  been  called,  by  the  French  patho- 
logi^ts,  pulmo  kcpatizc.. 

The  most  common  disease,  which  we  are  called  upon  to 
examine,  is  that  of  phthisi-s  pitlmwMlis,  or  consumption. 

When  WG  cut  into  the  lung  of  a  person  who  has  died  in 
the  early  stage  of  this  disease,  we  hhall  find  groupes  of  little 
white,  or  variegated  bodies,  which  are  called  tubercles. — 
They  vary  in  size,  from  that  of  a  pin's  head,  to  that  of  a  bean. 
When  the  disease  is  farther  advanced,  tubercles  make  the 
surface  of  the  lung,  hard  and  irregular:  and  when  cut  into, 
they  are  found  to  have  run  into  masses,  in  which  there  are 
little  abscesses,  or  vomicce; — some  of  the  tubercles  may  still 
be  distinct  from  the  others,  and,  when  opened,  are  found  to 
contain  a  thick  white  pus.  In  those  patisnts  who  have  long 
borne  out  against  the  disease,  large  abscesses,  or  vomic«, 
are  found:  in  such  cases,  when  the  chest  is  opened,  the 
lungs  will  be  found  compressed, — hard  coagulable  lymph 
will  be  exuded  upon  the  surface  of  the  pleura,  a.nd  partitions 
will  expend  from  the  inner  surface  of  the  ribs  to  the  collaps- 
ed and  indurate.  1  lungs  :  sinuses  of  matter  will  be  seen  run- 
ning among  these  irregular  adhesions,  and  the  lungs  them- 
selves will  contain  small  purulent  abscesses,  or  large  vomicae, 
and  will,  in  other  parts,  be  full  of  irregular  tumours,  in  all 
the  various  stages  of  inflammation  and  suppuration. 

The  state  of  the  large  vessels,  in  these  great  abscesses, 
is  very  extraordinary ;  for  they  will  sometimes  be  found  with 
open  mouth?,  projecting  into  the  sac, — more  commonly, 
however,  with  their  mouths  plugged  up  with  coagula,  like 
the  arteries  of  a  stump  after  amputation. 

Tumours  will  sometimes  be  found  projecting  from  the  sur- 
face of  the  lungs,  and  widely  interspersed  in  their  substance, 
of  quite  a  different  texture  from  tubercles,  being  of  a  very 


210 

Vascular  and  porous,  or  cellular  nature  ;  perhaps  these  may 
may  be  called  sanguineous  tumours.  Those  upon  the  surface, 
are  of  a  reddish  colour,  and  are  covered  with  a  smooth  mem- 
brane. These  are  often  found  in  those  subjects,  in  which 
there  is  a  similarly  diseased  structure  in  the  liver  and  lym- 
phatic glands,  and  in  the  substance  of  the  testicle.  Indeed, 
when  the  lungs  are  diseased,  we  .generally  find  that  the 
lymphatic  glands  and  particularly,  the  mesenteric  glands,  are 
in  the  same  state.  There  is  OL«  species  of  tubercle  that  is 
very  rarely  seen, — viz.  a  soft  pulpy  tubercle,  of  a  light  brown 
colour. 

In  a  broken-winded  horse,  the  air  cells  are  sometimes  found 
ruptured,  so  that  several  communicate  with  each  other,  and 
form  large  cysts.  Something  of  the  same  kind  has  been 
found  in  those  who  have  long  suffered  frcm  asthma.  Such 
an  appearance  was  found  in  the  lungs  of  the  famous  Dr. 
Samuel  Johnson.  This  has  been  called  enip/iy&ema  pulmo- 
num :  it  is  a  very  different  affection  from  that  of  the  air  vesi- 
cles, which  are  occasionally  found  adherent  to  the  surface  of 
the  lungs. 

Burst  hydalids  are  occasionally  coughed  up ;  but  as  they 
are  very  seldom  found  in  the  lungs,  it  is  supposed  that  they 
are  formed  in  the  liver,  and,  that  by  a  process  of  liberation, 
a  communication  is  formed  between  the  sac  in  the  liver,  con- 
taining the  hydatids,  and  the  lung. 

Earthy  concretions  are  so  frequently  found  at  the  toots  of 
the  lungs,  that  I  am  inclined  to  think  they  are  very  Common 
in  s-crophulous  constitutions  :  they  are  generally  situated 
near  the  branching  of  the  bronchii.  And  here,  though  the 
subject  is  not  connected  with  these  concretions,  I  may  re- 
mark, that  the  first  appearance  of  abscess  in  the  lung  will 
generally  be  found  at  the  upper  part,— and  I  think,  more  fre- 
quently on  the  left  side,  than  on  the  right. 

If  there  has  been  a  cancer  of  the  breast,  which  has  extend- 
ed to  the  bone,  it  will  generally  affect  the  lung  also.  I  think 
I  have  found  this  happen  most  frequently  in  those  patients 
who  have  had  that  sort  of  cancer  which  has  been  considered 
as  a  species 'vf fungus  h&mqtodes.  In  examining  the  body  of 
a  person  who  has  died  of  tungus  tsematodes,  we  should  al- 
ways attend  to  the  state  of  Ihe  lungs,  for  they  appear  to  be  as 
frequently  affected  with  this  disease,  as  the  liver. 

If  a  patient  dies  of  irritation  in  the  larynx,  the  lungs  will 
generally  be  found  in  a  state  of  congestion,  and  wiil  not  col- 
lapse ;  proving,  that  the  patient  has  died  in  consequence  of 
the  gradual  destruction  of  the  lung,  as  a  respitory  organ,  by 
the  extravasation  of  serum  mto  its  cellular  membrane. 

In  those  children  who  die  ot  croup,  the  membrane  may  be 


217 

traced  into  the  branches  of  the  bronchii,  and  the  cells'wili 
bo  tilled  with  purulent  matter. 

In  those  who  die  suddenly  from  the  bursting  of  an  aneu- 
rism of  the  aorta,  or  from  'Hemoptysis,  the  whole  of  the  bron- 
chii  will  sbmetimes  be  {bund  so  distended  with  blood,  that 
it  must  have  prevented  lyry  air  from  being  drawn  into  the 
cells. 

The  first  thing  we  should  attend  to  in  the  examination  of 
the  heart,  is  the  state  of  the  pericardium.  If  the  patient  has 
suffered  from  a  lingering  disease,  or  if  there  be  water  in  the 
pleura,  we  shall  probably  iind  some  fluid  in  the  pericardium  ; 
but  a  small  quantity  of  water  is  so  frequently  found  within 
this  membrane,  that  we  cannot  attach  much  importance  to 
it  :  indeed,  this  has  been  considered  so  natural  a  state  of  the 
pericardium,  that  the  fluid  has  been  called  liquor  pericardii  ; 
but  the  quantity  occasionally  found  is  so  great,  that  it  must 
have  impeded  the  action  of  the  heart. 

The  pericardium  is  very  frequently  found  adhering  to  the 
heart.  If  we  were  to  compare  the  number  of  cases  which 
are  now  seen  of  this,  which  appears  to  be  a  consequence  of 
violent  inflammation  of  the  internal  surface  of  the  pericardi- 
um^ with  the  importance  which  the  older  authors  attached  to 
the  few  cases  recorded,  we  should  be  inclined  to  say  that 
the  disease  of  pericarditis  must  be  much  more  common  now 
than  formerly.  I  have  frequently  found  the  lymph  between 
the  pericardium  and  the  heart,  a  quarter  of  an  mch  in  thick- 
ness :  in  such  cases,  the  disease  had  been  evidently  chronic ; 
as  there  were  several  distinct  layers  of  nymph,  the  most  in- 
ternal of  which  I  have  been  able  to  inject.  But  in  those  ca- 
ses in  which  patients  die  atler  thirty  hour's  illness,  we  shall 
generally  Iind  only  a  very  delicate  layer  of  lymph  between 
the  pericardium  and  the  heart. 

The  surface  of  the  heart  which  corresponds  to  the  part  of 
the  pericardium  that  adheres  to  the  diaphragm,  very  often 
appears  of  a  white  colour,  one  portion  about  the  size  of  a 
shilling,  being  denser  than  the  rest, — and  sometimes  a  loose 
portion  of  membrane  is  attached  to  it ;  but  this  appearance 
is  so  very  often  found  in  the  hearts  of  old  people,  that  it  can- 
not be  considered  of  any  importance.  Ossification  of  the 
substance  of  the  heart  will  be  more  frequently  found  than 
ossification  of  the  pericardium. 

The  heart  is  sometimes  monstrously  enlarged  ;  but  we 
ought  to  make  a  distinction  between  the  cases  of  enlarge- 
ment. In  a  dropsical  body,  or  that  of  a  person  who  has  evi^ 
dently  laboured  long  under  the  effects  of  what  is  called  a 
broken  down  constitution,  we  shall  find  a  large  flabby  heart, 
the  walls  of  which  are  so  soft,  that,  in  examination,  the  tin- 
T 


218 

ger  will  pass  through  them.  If,  in  such  cases,  we  examine 
the  valves,  we  shall  probably  find  them  in  a  natural  state ; 
but  if  the  heart  is  large,  and  if,  at  the  same  time,  there  be 
marks  of  long  continued  irritation  upon  its  surface,  we  shall 
probably  find  the  valves  of  the  aorta  so  diseased,  as  to  have 
caused  an  actual  obstruction  to  the  exit  of  the  blood.  In 
such  a  case,  the  state  of  the  heart  is  very  analogous  to  that 
of  a  bladder  when  there  has  been  a  stricture  in  the  urethra. 

The  large  flabby  heart  has  been  sometimes  called  Aneu- 
rism,— but  this  is  a  mistake  ;  the  true  aneurism  is  very  sel- 
dom found.  In  such  a  case,  the  heart  is  not  generally  en- 
larged ;  but  according  to  the  best  authorities,  there  is  a  pro- 
jecting tumour  from  the  side  of  one  of  the  ventricles.  But 
in  the  only  distinct  case  of  aneurism  of  the  heart  which  I 
have  examined,  there  was  a  cyst  formed  in  the  wall  of  the 
ventricle,  which  was  not  observable  until  the  heart  was 
opened :  In  this  case,  there  was  an  opening  in  the  cyst, 
which  admitted  a  probe  ;  and  by  this,  the  blood  had  escaped 
into  the  pericardium. 

Rupture  of  the  heart  is,  certainly,  a  very  rare  occurrence  ; 
but,  during  the  course  of  the  last  ten  months,  I  have  met 
with  three  examples  of  it.  One,  of  the  right  auricle,  which 
was  in  the  heart  of  a  young  woman,  and  from  the  history 
given  by  her  friends,  appeared  to  have  been  produced  by  a 
sudden  fright.  The  other  two  examples  were  in  the  ventri- 
cles, and  in  old  people,  who,  from  the  state  of  their  bodies, 
which  were  brought  into  the  dissecting  room,)  appeared  to 
have  been  in  full  health  previous  to  the  moment  of  their 
death.  In  each  of  the  three  cases,  the  pericardium  was 
stuffed  with  blood. 

In  examining  the  interior  of  the  heart,  we  should  proceed 
in  the  same  manner  as  if  we  were  dissecting  it  to  show  the 
natural  anatomy.  In  the  right  auricle,  we  may  perhaps  find 
the  foramen  ovale  open ;  but  this  is  so  common,  that  we 
cannot  attach  much  importance  to  it.  I  have  found  in  the 
heart  of  a  strong  drayman,  who  dropped  down  dead  in  the 
streets,  inconsequence  of  the  rupture  of  the  aorta,  an  open- 
ing in  the  septum  auriculorum,  which  would  admit  four  fin- 
gers. It  did  not  appear  that  this  man  had  ever  suffered  from 
any  affection  that  could  be  referable  to  the  state  of  the  heart. 
The  circumstance  of  his  having  died  from  the  rupture  of  the 
aorta,  seems  to  be  an  argument  against  supposing  that  the 
action  of  the  heart  had  been  deteriorated  by  this  opening. 

The  tricuspid  valve  is  very  frequently  ossified  ;  but  unless 
we  find  this  in  the  heart  of  a  young  person,  we  should  not  at- 
tach much  importance  to  it.  Within  the  right  ventricle,  we 
shall  generally  find  more  blood  than  in  the  left ;  and  in  that 


219 

state  of  coagulation,  which  has,  by  many,  been  called  Poly- 
pus. 

That  these  polypi  are,  for  the  most  part,  formed  after 
death,  there  can  be  little  doubt ;  but  still  there  are  circum- 
stances which  have  induced  many  to  believe  that  they  are 
formed  during  life.  They  are  often  found  in  layers  ;.  and 
this,  it  is  said,  argues  a  successive  formation  ;  or  they  are 
attached  to  the  sides  of  the  arteries,  where  their  coats  are 
diseased, — and  their  attachment  does  not  appear  to  be 'acci- 
dental, or  owing  to  the  simple  coagulation  of  the  blood.  In 
many  instances,  however,  when  these  coagula  are  remarka- 
bly firm,  and  such  as  we  might  suppose  were  formed  during 
life,  we  shall  find,  upon  examination,  that  the  extremity, 
which  is  loose,  lies  in  a  direction  contrary  to  the  course  of 
the  blood  ;  a  direction  in  which  we  must  be  sensible  it  could 
not  have  remained  during  life,  for  it  must  have  been  driven 
in  the  direction  of  the  current  of  the  blood,  while  the  root  was 
held  nearer  the  heart.  In  the  centre  of  many  of  these  coag- 
ula, there  is  an  oily  fluid,  so  similar  to  pus,  that  I  have  seen 
such  cases  exhibited  as  examples  of  abscess  in  the  interior  of 
the  heart. 

Abscess  in  the  walls  of  the  ventricle  is  a  very  uncommon 
case  ;  I  have  only  seen  one  or  two  examples  of  it :  but  I  have 
dissected  a  heart,,  in  the  muscular  substance  of  which,  there 
were  tubercles,  which,  though  not  in  a  state  of  suppuration, 
might,  from  their  appearance,  be  called  scrophulous. 

Malformations  of  the  Heart. — We  sometimes  see  an  open- 
ing in  the  septum  ventriculorum  :  several  preparations  of  this 
kind  are  preserved  in  the  museum,  in  Great  Windmill-street, 
one  of  which  was  taken  from  che  body  of  a  gentleman  fifty- 
six  years  of  age,  who  had,  six  hours  previous  to  his  death, 
gone  through  the  exercise  with  the  musket  without  suffer- 
ing any  inconvenience.  In  dissecting  a  puer  cceruleus,  we 
shall  generally  find  that  the  pulmonary  artery  is  very  small, 
or  that  it  passes  into  the  aorta.  In  several  of  these  cases, 
there  will  be  a  hole  found  in  the  septum,  so  that  if  a  probe 
be  passed  from  the  aorta,  it  will  be  found  to  pass  as  easily  in- 
to the  right  as  into  the  left  ventricle. 

The  valves  of  the  pulmonary  artery  are  very  seldom  found 
diseased.  In  the  left  auricle,  we  seldom  see  any  marks  of 
disease,  but  the  osteum  arteriosum  is  very  often  contracted  ; 
indeed,  the  whole  apparatus  of  the  mitral  valve  is  more  fre- 
quently ossified  than  the  tricuspid. 

Within  the  left  ventricle,  we  shall  find  the  same  polypi  as 
in  the  right,  but  not  in  the  same'quantity,  as  the  blood  is  gene- 
rally propelled  from  this  cavity  in  the  last  struggles.  The 
most  common  appearance  of  disease  in  the  heart,  is  ossifica- 


220 

tion  of  the  valves  of  the  aorta.  I  am  inclined  to  think  thai 
this  is  so  far  a  natural  consequence  of  old  age,  that  it  doep 
not  produce  much  distress  in  a  person  above  the  age  of  six- 
ty ;  but  in  a  young  person,  whose  left  ventricle  is  still  in  a 
vigorous  state,  the  consequences  are  terrible  ;  for  we  find 
the  heart  sometimes  increased  to  nearly  the  size  of  that  of  a 
bullock,  and  bearing  evident  marks  of  inflammation. 

The  disease  of  Angina  Pecioris  is  generally  ascribed,  and 
perhaps  correctly,  to  ossification  of  the  coronary  arteries  ; 
but  I  am  inclined  to  doubt  the  correctness  of  this  opinion,  when 
I  find  in  almost  every  body  above  the  age  of  fifty,  that  these 
vessels  are  more  or  less  ossified.  In  many  okl  people,  who 
I  know  never  had  the  slightest  symptom  of  angina ,  I  feave^ 
found  the  coronary  arteries  like  tubes  of  bone,  through  their 
whole  course. 

When  the  heart  is  very  large,  we  shall  not  find  the  aorta 
increased  in  size,  but,  on  the  contrary,  smaller  than  natural. 

The  aorta  is  frequently  much  dilated,  immediately  after  it 
rises  from  the  heart.  This  state  of  the  vessel  is  generally 
found  in  old  people  :  and  when  such  a  vessel  is  opened,  there 
will  be,  at  certain  points,  white  spots  below  the  inner  coat,— 
and,  at  other  parts,  distinct  concretions,  which  are  generally 
called  ossifications. 

This  state  of  the  aorta  is  so  common,  that  we  should  not 
attach  much  importance  to  it  in  drawing  up  a  report  of  the 
dissection  of  a  person  advanced  in  years.  In  the  dissection 
of  those  aneurisms  which  occur  so  frequently  at  the  arch,  we 
generally  find  the  aorta  to  be  dilated  through  almost  its 
whole  course.  We  may  suspect  that  the  dilation  which  I 
have  just  described  as  common  in  old  people,  may  be  the  pri- 
mary state  of  an  aneurism;  for,  if  we  minutely  exomine  an 
artery  which  is  dilated,  we  shall  generally  find  one  point 
thinner  than  the  rest,  which,  had  the  patient  lived  longer, 
would  probably  have  given  way,  and  then  an  aneurismal  tu- 
mour would  have  been  formed  at  the  part. 

When  a  patient  dies  o  a  large  aneurism  which  has  formed 
a  projecting  tumour,  we  should  proceed,  in  making  the  exa- 
mination of  it,  nearly  in  the  following  manner  :— 

The  integuments  should  be  dissected  off  from  the  tumour 
on  the  breast,  and  then,  after  calculating  Low  fp,r  the  bones 
are  affected,  we  should  endeavour  to  remove  the  sternum 
with  the  heart,  and  the  aneurism  attached  to  it.  We  shall 
then  be  able  to  make  a  more  careful  examination  of  the  parts. 
If  we  make  a  section  of  the  sternum,  and  of  the  aneurismal 
sac,  we  shall  see  the  clot,  probably,  in  several  layers :  the  etn 
foct  of  the  pressure  on  the  bony  part  of  the  sternum  should 
also  be  attended  to.  The  sac* itself  will  appear  thick  an,4 


221 

iamellated,  and  studded  with  concretions,  which  are  imbued 
in  a  matter  resembling  pus.  The  heart  will  probably  be 
small  and  firm  in  its  texture,  and  the  valves  of  the  aorta  will 
be  thickened,  and  white  with  concretions. 

The  idea  that  it  is  necessary  to  cut  through  the  internal 
coat  of  an  artery,  with  the  ligature,  to  ensure  the  closing  of 
the  vessel,  is  so  common,  that  I  think  it  necessary  to  entreat 
the  student  to  attend  to  this  subject,  as  far  as  he  can,  in  the 
dissecting-room. 

In  preparing  to  inject  a  limb  where  the  arteries  are  in  the 
state  in  which  they  are  generally  found  in  a  patient  with 
aneurism,  if  we  apply  the  ligature  tightly  upon  the  pipe 
which  is  in  the  artery,  we  shall  cut  through,  not  only  the  in- 
ternal, but  also  the  muscular  coat ;  so  that  only  the  cellular 
coat  shall  remain :  if  we  then  throw  in  the  injection,  it  will 
most  probably  escape  by  the  side  of  the  ligature.  If  we  tie 
the  artery  in  the  same  manner,  at  some  distance  down  the 
limb,  the  coats  will  give  way,  when  the  injection  is  pushed, 
even  with  a  moderate  force,  against  the  part  tied.  Here, 
then,  is  sufficient  proof  that  the  vessel  must  be  very  much 
weakened,  by  this  mode  of  applying  a  ligature.  As  to  the 
idea  that  the  union  of  the  artery  will  not  take  place  readily, 
where  the  ligature  does  not  cut  through  the  internal  coat, — 
I  shall  only  say,  that  I  have  repeated  the  experiment  which 
was  made  by  Mr.  Bell  (when  the  notion  of  the  necessity  of 
cutting  the  internal  coat  was  first  advanced  by  Dr.  Jones,) 
of  putting  a  ligature  so  loosely  round  the  carotid  of  an  ass,  as 
not  even  to  obstruct  the  passage  of  the  blood  ;  yet,  in  due 
time,  a  clot  was  formed,  lymph  was  thrown  out,  and  the  sides 
of  the  artery  were  united.  I  shall  not  dwell  longer  on  this 
subject,  but  refer  the  student  to  the  paper  on  the  ligature  of 
arteries,  in  Mr.  C.  Bell's  Surgical  Observations. 


METHOD  OF  INJECTING  THE  HEART  AND 
GREAT  VESSELS, 

That  the  description  of  the  manner  of  examining  the  heart 
may  be  more  complete,  I  shall  here  show  the  method  of  in- 
jecting the  heart  and  great  vessels,  so  that  they  may  after- 
wards be  preserved.  This,  however,  is  a  piece  of  dissection 
which  a  student  should  not  attempt  until  he  is  considerably 
advanced  in  the  knowledge  of  anatomy. — I  shall  presently 
describe  the  manner  of  injecting  the  great  arteries  of  the 
chest,  for  the  common  dissection  of  the  vessels  of  the  head 
and  arm ; — to  that  part  of  the  work,  the  student  should  re- 


222 

fer,  for  the  description  of  the  first  dissection  of  the  arteries 
of  the  chest. 

Old  subjects  should  never  be  taken  for  the  purpose  of  pre- 
paring the  arteries  of  any  of  the  viscera  :  for,  in  old  age, 
the  fat  is  accumulated  about  the  viscera  both  of  the  abdomen 
and  of  the  thorax.  Nor  is  the  fat  here  deposited,  derived 
from  the  extremities  ;  for  although,  during  life,  the  limbs  of 
old  people  seem  shrivelled  and  lean, — yet  the  oil  contained 
in  them,  makes  them  also  useless  for  preparing : — for,  al- 
though dried  with  the  utmost  care,  the  oil  will  occasionally 
flow  out,  and  mix  with  and  dissolve  the  varnish,  so  that  they 
never  are  clean  nor  lasting  preparations.  If  the  heart, 
therefore,  has  much  fat  accumulated  about  it,  there  should 
be  no  hesitation  in  sacrificing  it  as  a  preparation,  to  the  at- 
tainment of  some  other  point  of  inquiry. 

If  we  wish  to  inject  the  heart  while  it  is  in  its  natural 
situation,  we  must  sacrifice  almost  all  the  parts  of  the  chest 
to  it ;  for  it  is  a  preparation  so  difficult  to  make,  and  so  ex- 
pensive, that  wrhen  we  undertake  it,  we  must  not  hesitate  to 
destroy  the  other  parts.  The  chest,  for  this  purpose,  is  to  be 
opened  by  cutting  through  the  sternum  in  its  length,  and  by 
bending  back  the  lateral  portions,  in  the  manner  already  de- 
scribed at  page  201.  The  abdomen  must  also  be  opened. 
The  viscera  are  to  be  pulled  down,  so  that  a  large  pipe  may 
be  put  into  the  aorta,  where  it  lies  between  the  crura  of  the 
diaphragm.  Another  pipe  is  to  be  put  into  the  vena  cava 
ascendens,  below  the  liver. 

We  must  then  make  a  dissection  on  each  side  of  the  neck, 
so  as  to  expose  the  internal  jugular  veins,  into  each  of  which, 
a  pipe  should  be  put.  The  carotid  and  vertebral  arteries  are 
to  be  tied  ;  so  are  the  subclavian  :  or  perhaps  it  will  be  bet- 
ter to  put  tight  ligatures  on  the  arms,  just  below  the  insertion 
of  the  pectoralis  major. 

Previous  to  the  injection  of  the  veins,  a  quantity  of  warm 
water  should  be  thrown  into  them,  so  that  it  may  pass  into 
the  several  cavities  of  the  heart.  The  water  is  then  to  be 
pressed  out  along  with  the  coagula  which  are  generally  found 
in  the  cavities  of  the  heart. — It  is  principally  upon  this  being 
carefully  done,  that  a  good  injection  of  the  heart  depends. 

When  the  parts  are  thoroughly  heated,  the  red  injection 
should  be  thrown  into  the  ascending  aorta.  An  assistant 
must  now  be  ready  to  knead  the  injection  through  the  valves 
of  the  aorta;  (but,  if  possible,  a  probe  should  have  been  pass- 
ed from  the  carotid,  before  it  was  tied,  to  break  down  these 
valves;)  when  the  injection  once  passes  the  vales,  it  will 
quickly  distend  the  left  ventricle,  which  must  be  supported 
by  the  assistant, — the  pericardium  having  been  previously 


opened.  By  a  little  pressure,  the  wax  will,  pass  into  the  left 
auricle,  and,  from  it,  into  the  pulmonary  veins.  It  will 
be  well  to  make  a  small  puncture,  with  a  lancet,  in  the  apex 
of  the  ventricle,  to  allow  of  the  escape  of  any  water  or  blood 
which  may  be  still  in  this  side  of  the  heart. 

The  right  side  of  the  heart  may  be  filled  with  blue  or  yel- 
low injection  from  the  pipes  which  have  been  put  into  the  se- 
veral veins.  It  will  be  necessary  to  make  a  puncture  in  the 
apex  of  the  auricle,  to  permit  the  exit  of  a  certain  quantity 
of  water  which  will  be  left  in  the  heart,  even  though  much 
care  has  been  taken  to  squeeze  at  all  out  previous  to  the  in- 
jection. 

Perhaps  the  vena  azygos  may  be  filled,  with  the  other 
veins;  but  if  it  be  not,  we  must  put  a  pipe  into  it,  and  inject 
it  separately. 

The  thoracic  duct  may  also  be  injected.  If  sought  for 
in  the  abdomen,  it  will  be  discovered  at  the  root  of  the  me- 
senteric  vessels,  or  between  the  right  crus  of  the  diaphragm 
and  the  aorta.  It  may  be  traced  up  under  the  diaphragm, 
along  with  the  aorta,  and  upon  its  right  side,  close  to  the 
spine.  As  it  generally  lies  collapsed  and  undistinguishable, 
it  may  be  raised  by  blowing  into  some  of  the  glands  upon  the 
root  of  the  mesentery,  or  into  those  upon  the  course  of  the 
external  iliac  vessels,  or  even  into  those  below  Poupart's  lig- 
ament in  the  groin.  It  must  be,  injected  with  a  different  co- 
lour from  the  Veins,  that  it  may  not  be  confounded,  in  the 
thorax  and  at  the  root  of  the  neck,  with  their  branches. 

When  the  heart  only  is  to  be  injected,  we  should  cut 
through  the  vessels  going  to  the  upper  parts  of  the  body,  as 
they  are  emerging  from  the  thorax,  and  remove  the  heart  and 
lungs,  by  tearing  them,  along  with  the  trachea  and  esopha- 
gus, from  the  spine, — making  first  an  incision  along  the 
spine,  to  free  the  intercostal  arteries.  We  may  then  cut 
through  the  aorta  and  vena  cava,  below  the  diaphragm : — a 
part  of  the  liver  should  be  left  attached  to  the  vessels.  It  is 
necessary  to  remove  the  heart  in  this  manner,  that  there  may 
be  no  danger  of  cutting  any  of  the  great  vessels. 

We  should  press  out  as  much  blood  as  possible  from  the 
vessels,  and  then  put  a  pipe  into  one  of  the  pulmonary  veins, 
and  another  into  the  vena  cava  superior.  Having  injected 
warm  water  by  these  tubes,  to  clear  the  heart  of  the  masses 
of  coagulated  blood  which  aie  generally  found  in  it  after 
death,  we  must  tie  the  lungs  at  their  roots,  and  the  vena  cava 
inferior,  and  all  the  divided  arteries,  except  the  aorta,  in 
which  a  pipe  must  be  put.  If  we  throw  red  injection  into 
the  pulmonary  vein,  it  will  fill  the  left  auricle,  left  ventricle, 
aorta,  and  coronary  vessels  ;  but  during  this  part  of  the  i»- 


224 

jection,  an  assistant  ought  to  hold  and  compress  the  aorta  im- 
mediately after  its  giving-  off  the  coronary  arteries,  so  as  to 
press  the  injection  on  in  them  ;  but  as  by  this  the  injection 
will  be  prevented  from  entering  the  aorta,  it  must  be  filled 
from  the  pipe  which  was  inserted  into  it.  The  injection  es- 
caping by  the  intercostal  arteries,  may  be  stopped  by  an  as- 
sistant throwing  cold  water  on  the  wax  as  it  flows  from  the 
vessels.  The  yellow  injection  thrown  in  by  the  vena  cava 
superior,  will  fill  the  right  auricle,  ventricle,  and  pulmonary 
artery.  The  dissection  required  is  simply  the  removing  of 
the  soft  parts  from  the  injected  vessels. 


OF  THE  MAMMA. 

The  structure  of  the  mamma  should  be  attended  to.  Much 
of  its  bulk  is  made  up  of  the  fat  and  cellular  membrane  sur- 
rounding the  proper  glandular  part,  which  is  formed  of  a  con- 
geries of  lesser  glands,  that  are  connected  by  their  ducts  and 
vessels.  The  arteries  of  the  gland  come  from  different 
sources :  those  from  the  internal  mammary  may  be  traced 
from  betwixt  the  ribs,  and  through  the  pectoral  muscles.  It 
has  also  branches  from  the  external  mammary,  or  thoracic 
arteries,  and  from  the  intercostal^ — all  of  which  become 
much  more  important  when  the  gland  is  secreting  milk,  or 
when  it  is  enlarged  and  diseased.  A  very  remarkable  inos- 
culation may  be  traced  between  the  internal  mammary  and 
the  epigastric  artery,  by  which  the  sympathy  between  the 
womb  and  the  breast  has  been,  by  some,  explained  ;  but  this 
connection  depends  upon  other  laws  of  the  economy.  The 
veins  are  all  very  large,  when  the  gland  is  in  an  active  state. 
The  lymphatics  pass  chiefly  towards  the  glands  in  the  axilla, 
but  some  will  be  found  to  pass  to  the  glands  above  the  clavi- 
cle. 

We  should  observe  the  elastic  structure  of  the  Nipple,  or 
Papilla  ;  the  glandular  structure  of  the  skin  around  the  nip- 
ple ;  the  opening  of  the  Lactiferous  Ducts.  When  distended, 
these  ducts  take  an  irregular  varicose-like  form.  The  ducts 
are  contracted  before  they  terminate  on  the  nipple ;  and  the 
structure  of  their  orifices  is  such,  as  only  to  allow  the  milk 
to  pass  when  the  nipple  is  drawn  out  by  the  sucking  of  the 
child.  The  areola,  or  dark  coloured  zone  surrounding  the 
nipple,  will  be  found  of  a  paler  colour  in  girls ;  it  changes  to 
a  darker  colour  during  menstruation,  and  in  women  with 
child,  or  when  giving  suck.  The  glandular  structure  of  the 
areola  and  nipple,  appears  to  be,  to  prevent  excoriation  ;  but 
like  all  glandular  parts,  it  is  subject  to  disease. 


225 

It  must  be  allowed  by  every  one,  that  there  is  no  question 
in  pathology  more  important,  than  the  difference  between 
harmless  tumours  of  the  breast,  and  those  which  it  may  be 
necessary  to  extirpate.  But,  unfortunately,  we  find  great 
difficulty  in  preserving  the  morbid  appearances  of  this  gland. 

Though  we  have  been  unable  to  preserve  the  characteris- 
tic appearances  of  the  internal  structure  of  the  several  varie- 
ties of  tumours  of  the  breast,  still,  accurate  drawings  have 
been  taken  of  the  external  characters  of  each  species  of  tu- 
mour, and  which  are  used  by  Mr.  Bell,  in  his  Lectures  on 
Cancer.  When  the  age  of  the  patient  is  also  taken  into  con- 
sideration, it  would  appear,  from  the  immense  number  of  ca- 
ses that  have  occurred  in  the  cancer  ward  of  the  Middlesex 
Hospital,  that  the  external  appearance  of  a  tumour  forms  a 
better  criterion  for  the  rule  of  practice,  than  any  that  can  be 
deduced  from  the  section  of  it ;  for  we  not  only  rind,  that 
different  tumours,  when  cut  into,  resemble  each  other,  but 
that -even  a  section  of  the  virgin  breast  may  be  mistaken,  by 
those  who  are  not  conversant  with  the  subject,  for  a  scirrh- 
ous  tumour.  When  the  section  of  a  large  healthy  breast  is 
put  into  spirits,  and  compared  with  a  preparation  of  a  section 
of  a  scirrhous  breast,  that  has  not  run  into  ulceration0 — I  be- 
lieve that  even  good  judges  of  preparations,  may  be  led  to 
believe,  that  both  specimens  are  examples  of  the  same  die^ 
ease. 


DISSECTION 


MUSCLES.  OF  THE  BACK. 


1  shall  now  suppose,  that  the  student  who  is  making  the 
fi-r. *f  dissection  of  the  upper  part  of  the  body,  has  examined 
the  general  anatomy  of  the  viscera  of  the  thorax,  and  that  lie 
is  prepared  to  turn  the  body,  to  expose  the  muscles  of  the 
back. 

The  first  muscles  which  are  to  be  dissected,  are  those 
which  are  connected  with  the  arms.  The  body  must  be  put 
into  such  a  position,  that  the  fibres  of  those  muscles  may  be 
made  tense  ;  this  may  be  done  by  putting  blocks  of  wood 


226 

under  the  chest,  so  as  to  elevate  it ;  and  then  to  let  the  head 
and  arms  hang  doivn. 

To  expose  the  first  layer  of  muscles  which  is  formed  by 
the  Latissimus  Dorsi  and  Trapezius,  we  should  make  an  in- 
cision along  the  whole  length  of  the  spine,  and  another  from 
the  last  dorsal  vertebra,  in  an  oblique  direction,  to  the  spine 
of  the  scapula,  along  which,  it  is  to  be  continued  to  the  acro- 
mion.  Another  cut  is  then  to  be  made  from  the  acromion  to 
the  tubercle  of  the  occipital  bone.  These  three  incisions 
will  nearly  mark  the  boundaries  of  the  Trapezius;  but,  as 
the  middle  fibres  of  this  muscle  pass  directly  across  from  the 
spine  to  the  scapula,  the  dissection  will  be  much  facilitated, 
if  an  incision  be  made  through  the  skin,  from  the  first  dorsal 
vertebra,  to  the  middle  of  the  spine  of  the  scapula.  The  dis- 
section is  to  be  commenced  at  this  cut,  and  is  to  be  continu- 
ed, first,  towards  the  lower  oblique  incision,  and  then  to- 
wards the  upper,  following  the  course  of  the  fibres. 

Another  incision  should  now  be  made  from  the  middle  of 
the  lumbar  vertebrae,  to  the  back  part  of  the  insertion  of  the 
ktissimus  dorsi,  in  the  arm.  The  fibres  of  this  muscle  will 
be  easily  exposed,  by  cutting  in  the  direction  of  this  last  in- 
cision. 

The  first  layer  of  muscles  will  now  be  fully  exposed,  being 
almost  entirely  formed  by  the  trapezius  and  latissimus  ;  but 
on  the  upper  and  outer  part  of  the  trapezius,  a  small  portion 
of  the  Splenius  will  be  seen,  and  in  the  space  between  the 
trapezius  and  latissimus  dorsi,  part  of  the  Rhomboideus  Ma- 
jor will  be  exposed. 

The  trapezius  should  now  be  raised  from  its  connections 
with  the  spine,  and  be  carried  towards  the  scapula.  In  do- 
ing this,  we  shall,  on  the  upper  part  of  the  neck,  expose  part 
of  the  Complex-us,  more  of  the  Spicnius,  and  the  greater  part 
ofiheLevatorScapulce;  which  last  muscle  passes  from  the 
transverse  processes  of  the  cervical  vertebrae,  to  the  superi- 
or angle  of  the  scapula.  When  th'e  lower  part  of  the  trape- 
zius is  raised,  the  greater  part  of  the  Rhomboideus  Major  and 
Rhomboideus  .TJfmor,  both  of  which  arise  from  the  spine,  and 
are  attached  to  the  scapula,  will  be  exposed. 

The  muscular  part  of  the  latissimus  dorsi  should  now  be 
cut  through,  at  about  six  or  eight  inches  from  the  spine.  If 
we  divide  it  nearer  to  the  spine,  we  shall  probably  destroy 
the  small  muscle — the  Serratus  Posticus  Inferior,  which  is 
intimately  connected  with  the  tendon  of  the  latissimus.  Be- 
tween the  upper  margin  of  this  small  muscle,  and  the  lower 
margin  of  the  rhomboideus  major,  part  of  the  Longissimus 
7Jyr.iv'  and  Sacro  Lwnbalis  will  be  seen. 

After  dissecting  the  origins  and  insertions  of  the  Levator 


227 

Scapula?,  and  Rhomboideus  Major  and  Minor,  these  muscles 
may  be  cut  through ;  and  then,  by  sawing  through  the  clav- 
icle, or  by  dislocating  it  from  the  sternum,  the  arm  may  be 
removed  from  the  trunk.  The  arm  should  be  wrapped  up  in 
a  wet  cloth,  and  laid  in  a  cool  place,  so  that  it  may  be  pre- 
served, until  the  other  muscles  of  the  back  are  dissected. 

We  must  now  dissect  those  muscles  which  more  properly 
belong  to  the  spine  and  ribs.  When  the  rhomboidei  are 
thrown  back  towards  the  spine,  the  Serratus  Posticus  Supe- 
rior will  be  exposed ;  and  on  raising  this,  the  whole  of  the 
Splenius  may  be  seen.  This  muscle  is  generally  divided  into 
two  portions, — Splenius  Capitis  and  Splenius  Colli :  that  por- 
tion which  rises  from  the  cervical  vertebra,  and  is  inserted 
into  the  head,  being  the  splenius  capitis, — while  that  which 
rises  from  the  dorsal  vertebree,  and  is  attached  to  the  trans- 
verse process  of  the  cervical  vertebrae,  is  called  splenius 
colli.  The  splenius  should  now  be  cut  through  the  middle  : 
the  upper  half  is  to  be  reflected  towards  the  occiput,  and 
the  lower  towards  the  spine.  This  will  expose  the  third 
layer  of  muscles;  the  principal  ones  of  which,  are  the  Sacro 
Lumbalis  and  the  Longissimus  Dorsi. 

After  showing  the  insertions  of  the  sacro  lumbalis,  accor- 
ding to  the  description  given  in  the  annexed  table,  we  may 
trace  a  portion  of  muscle,  which  appears  to  be  a  continua- 
tion of  it,  upon  the  neck.  This,  however,  is  a  distinct  mus- 
cle, and  is  called  the  Cervicalis  Descendens.  If  we  follow  the 
longissimus  dorsi  in  the  same  manner,  we  shall  find  a  mus- 
cle, also  connected  with  its  upper  part,  but  not  so  distinct  as 
the  last  muscle, — it  is  the  Transversalis  Colli ;  immediately  up- 
on the  inside  of  which,  and  closely  connected  with  it,  is  a  set  of 
fibres,  which  run  from  the  lateral  part  of  the  vertebrae  to  the 
mastoid  process,  whence  these  fibres  are  called  the>  Tracks- 
lo  Jtfastqideus;  or,  sometimes,  from  their  intricacy,  the  corn- 
plexus  minor. 

We  shall  now  have  a  distinct  view  of  the  proper  Complex- 
us,  which  is  a  very  large  muscle.  That  part  of  it  which  is 
near  to  the  spine,  has  a  central  tendon,  whence  this  portion 
has  sometimes  been  described  as  a  separate  muscle,  under 
the  name  of  Biventer.  After  showing  the  numerous  attach- 
ments of  the  complexus,  it  is  to  be  raised  from  the  spinous 
processes,  and  from  the  occiput.  The  Semi-Spinalis  Colli 
will  now  be  seen  lying  close  upon  the  vertebra?  ;  and  there 
will  also  be  a  set  of  small  mnscles  exposed,  which  run  be- 
tween the  vertebra  dentata,  the  atlas,  and  the  occiput.  The 
one  which  runs  from  the  spinous  process  of  the  dentata  to 
the  occiput,  is  the  Rectus  Capitis  Posticus  Major ;  while  the 
one  which  runs  from  the  same  point,  to  the  transverse  pro- 


228 

cess  of  the  atlas,  is  the  Obli-quus  Capitis  Inferior  ;  and  from 
this  transverse  process,  a  set  of  fibres  may  be  traced  to  the 
occiput,  forming  the  muscle  called  Obliquus  Capitis  Superior. 
The  last  of  these  muscles  is  a  very  short  one,  which  arises 
from  the  knob  on  the  back  part  of  the  atlas,  and  is  inserted 
into  the  edge  of  the  foramen  magnum  ;  it  is  the  Rectus  Capi- 
tis  Minor. 

It  is  not  necessary  to  give  any  directions  for  the  dissection 
of  the  remaining  muscles  on  the  back.  It  only  requires  that 
their  origins  and  insertions  should  be  shown,  according  to 
the  description  given  in  the  annexed  table. 

There  are  still  certain  muscles  which  are  connected  with 
the  spine  and  ribs,  that  have  not  yet  been  described,  viz. 
those  upon  the  fore  and  lateral  parts  of  the  neck. 

Directly  on  the  fore  part  of  the  neck,  there  is  on  each  side 
a  long  and  thin  muscle,  which  is  called  Longus  Co//?.  This 
is  sometimes  divided  into  an  upper  and  lower  portion  :  the 
upper  portion  runs  obliquely  from  the  transverse  processes  of 
the  third,  fourth  and  fifth  cervical  vertebrae,  to  the  atlas  ; 
while  the  inferior  portion  runs  longitudinally  from  the  bodies 
of  the  three  upper  dorsal  vertebrae  to  the  bodies  of  the  six 
lower  cervical  vertebrae.  This  lower  portion  is  often  de- 
stroyed, by  the  vertebrae  having  been  broken  by  turning  the 
body  in  the  course  of  the  dissection. 

Upon  the  outer  part  of  the  upper  portion,  there  is  a  small 
muscle,  which  runs  from  the  transverse  processes  of  the 
third,  fourth,  fifth  and  sixth  cervical  vertebrae,  to  the  basilar 
process  of  the  occipital  bone  ;  it  is  the  Rectus  Anticus  Ma- 
jor : — the  Rectus  Anticus  Minor  being  a  very  small  muscle, 
which  rises  from  the  middle  of  the  atlas,  and  passes  to  the 
edge  of  the  condyle  of  the  occiput.  This  last  is  often  con- 
founded with  another  trifling  muscle — the  Rectos  Lateralis, 
which  arises  from  the  transverse  process  ofthe  atlas,  and  is 
inserted  between  the  condyie  of  the  occiput  and  the  niastoid 
process. 

These  muscles  which  have  just  been  described,  may  be  dis- 
sected before  those  of  the  back  ;  so  may  also  the  Scaleni, 
which  are  the  muscles  that  run  from  the  transverse  process- 
es of  the  cervical  vertebree  to  the  first  arid  second  rib.  These 
muscles  are  distinguished  from  each  other  by  the  terms  Sea- 
lenus  Anticus i  Scalenus  Medius,  and  Scaienus  Posticus.  We 
shall  have  no  difficulty  in  showing  the  anticus  as  a  distinct 
muscle,  but  the  medius  a,ndposticus  are  so  closely  connected, 
that  they  are,  by  many  anatomists,  described  as  one  muscle. 


229 

Iti  the  following  table,  the  muscles  are  arranged  nearly 
the  order  in  which  they  should  be  dissected. 

TABLE  OF  THE  MUSCLES  OF  THE  BACK. 

TRAPEZIUS,  or  CUCULARIS.  OR.  1.  The  protuberai 
in  the  middle  of  the  os  oecipitis,  by  a  thin  membranous  t< 
don,  which  covers  $art  of  the  splenius  and  complexus  m 
eles  ;  2.  from  the  transverse  ridge  of  the  occiput,  which  < 
tends  from  the  protuberance  towards  the  mastoid  process 
the  temporal  bone  ;  3.  from  the  ligarnentum  nuchae  :  bel 
this,  the  muscle  is  connected  with  its  fellow  ;  4.  from  1 
spinous  processes  of  the  two  inferior  vertebrae  of  the  ne< 
and  from  the  spinous  processes  of  all  the  vertebrae  of  1 
back. 

IN.  1.  The  outer  half  of  the  clavicle  ;  2.  the  acromio 
3.  the  spine  of  the  scapula. 

USE.  Moves  the  scapula  according  to  the  three  differ* 
directions  of  its  fibres  ;  for  the  upper  descending  fibres  m 
draw  it  obliquely  upwards,  the  middle,  being  transvei 
fibres,  directly  backwards,  and  the  inferior  ascending  fib] 
obliquely  downwards  and  backwards. 

LATISSIMUS  DORSI.  OR.  1-  The  posterior  part  of  t 
spine  of  the  os  ilium  ;  2.  all  the  spinous  processes  of  the 
sacrum  and  vertebrae  of  the  loins  ;  3.  the  seven  infer 
spines  of  the  vertebrae  of  the  back  ;  4.  the  extremities  of  t 
three  or  four  inferior  ribs.  Tke  inferior  fibres  ascend  < 
liquely,  and  the  superior  run  transversely  over  the  infer 
angle  of  the  scapula,  towards  the  axilla,  where  they  are 
collected. 

IN.  By  a  strong  thin  tendon  into  the  inner  edge  of  t 
groove  for  lodging  the  tendon  of  the  long  head  of  the  bicej: 
sometimes  into  the  tendon  of  the  triceps. 

USE.  To  pull  the  arm  backwards  and  downwards,  and 
roll  the  os  humeri. 

SERRATUS  POSTICUS  INFERIOR. — (Lying  under  the  latis 
mus  dorsi.) — OR.  In  common  with  that  of  the  latissim 
dorsi,  from  the  spinous  processes  of  the  two  inferior  ven 
brae  of  the  back,  and  from  the  three  superior  of  the  loins. 

IN.  The  lower  e.dges  of  the  four  inferior  ribs,  by  distil 
fleshy  slips. 

USE.  To  depress  the  ribs. 

RHOMBOIDEUS.  This  muscle  is  divided  into  twoportioi 
rhoniboideus  major  and  minor. 

U 


230 

RHOMBOIDEUS  MAJOR.  OR.  The  spinous  processes  of  the 
five  superior  vertebrae  of  the  back. 

IN.  The  basis  of  the  scapula,  below  its  spine. 

USE.  To  draw  the  scapula  obliquely  upwards  and  back- 
wards. 

RKOMBOIDEUS  MINOR.  OR.  The  spinous  processes  of  the 
three  inferior  vertebrae  of  the  neck,  and  from  the  ligamentum 
nuchce. 

IN.  The  base  of  the  scapulae,  opposite  to  its  spine. 

USE.  To  assist  the  former. 

LEVATOR  SCAPULJE.  OR.  The  transverse  processes  of 
the  five  superior  vertebrae  of  the  neck  :  the  slips  unite,  to  form 
a  muscle  that  runs  downwards. 

IN.  Near  the  superior  angle  of  the  scapula. 

USE.  To  pull  the  scapula  upwards. 

SERRATUS  POSTICUS  SUPERIOR.  OR.  The  spinous  pro- 
cess of  the  three  last  vertebrae  of  the  neck,  and  the  two  up- 
permost ojf  the  back. 

IN.  The  second,  third,  fourth  and  fifth  ribs. 

USE  To  elevate  the  ribs  and  dilate  the  thorax. 

SPLENIUS.  OR.  1.  The  four  superior  processes  of  the 
back  ;  2.  the  five  inferior  of  the  neck, — adheres  to  the  liga- 
mentum nuchse.  At  the  third  vertebrae  of  the  neck,  the  sple- 
nii  recede  from  each  other,  so  that  part  of  the  comptaxus  mus- 
cle is  seen. 

IN.  1.  The  five  superior  transverse  processes  of  the  ver- 
tebrae of  the  neck  ;  2.  the  posterior  part  of  the  mastoid  pro- 
cess ;  3.  the  os  occipitis. 

USE.  To  bring  the  head  'and  upper  vertebrae  of  the  neck 
backwards  and  laterally,  and,  when  both  act,  to  pull  the  head 
directly  backwards. 

That  portion  which  arises  from  the  five  inferior  spinous 
processes  of  the  neck,  and  is  inserted  into  the  mastoid  pro- 
cess and  os  occipitis,  is  called  Splenius  Capitis ;  and  that  por- 
tion which  arises  from  the  third  and  fourth  of  the  back,  and 
is  inserted  into  the  five  superior  transverse  processes  of  the 
neck,  is  called  Splenius  Colti. 

SACRO  LUMBALIS.  OR.  In  common  with  the  longissimus 
dorsi. 

IN.  All  the  ribs,  where  they  begin  to  be  curved  forwards, 
by  long  thin  tendons. 

From  Ui3  upper  part  of  the  six  or  eight  lower  ribs,  arise 
bundles  of  thin  fleshy  fibres,  which  soon  terminate  in  the  in- 
ner side  of  this  muscle,  and  are  named  Musculi  ad  Sacro-Lum~ 
balem  Accessorii. 


231 

USE.  To  pull  the  ribs  down,  and  assist  to  erect  the  trunk 
of  the  body. 

LONGISSIMUS  DORSI.  OR.  Tendinous  superficially,  and 
fleshy  within.  1.  From  the  side,  and  spines  of  the  os  sa- 
crum ;  2.  from  the  posterior  spine  of  the  os  ilii  ;  3.  from  all 
the  spinous  processes  of  the  loins  ;  4.  the  transverse  proces- 
ses of  the  vertebrae  of  the  loins. 

IN.  1.  All  the  transverse  processes  of  the  vertebrae  of  the 
back,  chiefly  by  small  double  tendons;  2.  by  a  tendinous  and 
fleshy  slip,  into  the  lower  edge  of  all  the  ribs,  except  the  two 
inferior,  at  a  little  distance  from  their  tubercles. 

USE.  To  raise  and  keep  the  trunk  of  the  body  erect. 

From  the  upper  part  of  this  muscle,  there  runs  up  a  round 
fleshy  portion,  which  joins  with  the  cervicalis  descendens. 

CERVICALIS  DESCENDENS.  OR.  From  the  upper  edge  of 
the  four  or  five  superior  ribs,  and  continued  from  the  sacro 
luinbalis. 

IN.  The  fourth,  fifth  and  sixth  transverse  processes  of  the 
vertebra?  of  the  neck,  by  distinct  tendons. 

USE.  To  turn  the  neck  obliquely  backwards,  and  to  one 
side. 

TRANSVERSAT,IS  COI.LI.  OR.  The  transverse  processes 
of  the  five  uppermost  vertebrae  of  the  back,  and  continued 
from  the  longissimus  dorsi. 

IN.  The  transverse  processes  of  the  cervical  vertebrae, 
from  the  second  to  the  sixth. 

TRACHELO  MASTOIDEUS.  OR.  The  transverse  processes 
of  the  three  uppermost  vertebrae  of  the  back,  and  from  the 
five  lowermost  of  the  neck,  by  thin  tendons. 

IN.  The  posterior  part  of  the  mastoid  process. 

USE.  To  assist  the  complexus  ;  but  it  pulls  the  head  more 
to  the  side. 

COMPLEXUS  Or.  1.  The  transverse  processes  of  the  se- 
ven superior  vertebrae  of  the  back,  and  four  inferior  of  the 
neck  ;  2.  by  a  fleshy  slip  from  the  spinous  process  of  the  first 
vertebrae  ofthe  back  :  from  these  different  origins  it  runs  up- 
wards, and  is  every  where  inter  mixed  with  tendinous  fibres. 

IN.  The  protuberance  of  the  os  occipitis,  and  transverse 
line. 

USE.  To  draw  the  head  backwards,  and  to  one  side,  when 
acting  as  an  individual  muscle ;  and  when  both  act,  to  draw 
the  head  directly  backwards. 

N.  B.  The  long  portion  of  this  muscle  that  is  situated  next 
the  spinous  processes,  lies  more  loose,  and  has  a  roundish  ten- 


don  in  the  middle  of  it ;  for  which  reason  Albinus  calls  it  bi~ 
venter  cervitis, — but  if  this  portion  should  be  called  biventer, 
the  term  "  complexus"  is  quite  misapplied  to  the  other  por- 
tion. 

SEMI-SPINALIS  COLLI.  OR.  The  transverse  processes 
of  the  six  uppermost  vertebrae  of  the  back  :  it  ascends  ob- 
liquely under  the  complexus. 

IN.  The  spinous  processes  of  all  the  vertebrae  of  the  neck, 
except  the  first  and  last. 

USE.  To  move  the  neck  backwards. 

RECTUS  CAPITUS  POSTICUS  MAJOR.  OR.  The  spinout 
process  of  the  second  vertebrae  of  the  neck. 

IN.  The  os  occipitus,  near  the  rectus  capitis  lateralis,  ans4 
the  insertion  of  the  obliquus  capitis  superior. 

USE.  To  pull  the  head  backwards,  and  to  assist  a  little  i» 
its  rotation. 

RECTUS  CAPITIS  POSTICUS  MINOR.  OR.  The  knob  in  the 
back  part  of  the  first  vertebras  of  the  neck. 

IN.  The  os  occipitis,  near  its  foramen  magnum. 

USE.  To  assist  the  rectus  major  in  moving  the  head  back- 
wards. 

OBLIQUUS  CAPITIS  SUPERIOR.  OR.  Tthe  transverse  pro- 
cess of  the  first  vertebrae  of  the  neck. 

IN.  The  os  occipitis,  near  the  mastoid  process  of  the  tem- 
poral bone,  and  under  the  insertion  of  the  complexus  muscle. 

USE.  To  draw  the  head  backwards. 

OBLIQ.UUS  CAPITIS  INFERIOR.  OR.  The  spinous  process 
of  the  second  vertebrae  of  the  neck. 

IN.  The  transverse  process  of  the  first  vertebrae  of  the 
neck. 

USE.  To  turn  the  head,  by  moving  the  atlas  on  the  denta- 
tus. 

SEMI-SPINALIS  DORSI,  OR.  The  transverse  processes  of 
the  seventh,  eighth,  ninth  and  tenth  of  the  vertebrae  of  the 
baek. 

IN.  Into  the  spinous  processes  of  all  the  vertebrae  of  the 
back,  above  the  eighth,  and  into  the  two  lowermost  of  the 
neck. 

USE.  To  poise  the  spine  and  support  the  trunk. 

SPINALIS  DORSI. — 'Lying  betwixt  the  spine  and  longissi- 
mus  dorsi.) — OR.  The  spinous  processes  of  the  two  upper- 
most vertebrae  of  the  loins,  and  the  three  inferior  of  the 
back. 


233 

IN.  The  apinous  processes  of  the  vertebrae  of  the  back, 
from  the  second  to  the  ninth. 

USE.  To  connect  and  fix  the  vertebrae,  and  to  assist  in 
raising-  the  spine. 

MULTIFIDUS  SPINJE.  OR.  1,  The  spines  of  the  os  sacrum; 
2.  the  part  of  the  os  ilium  where  it  joins  with  the  sacrum ;  3. 
the  oblique  and  transverse  processes  of  all  the  vertebrae  of 
the  loins ;  4.  the  transverse  processes  of  all  the  vertebrse  of 
the  back,  and  those  of  the  neck,  except  the  three  first,  by 
distinct  tendons,  which  soon  grow  fleshy,  and  run  in  an  ob- 
lique direction. 

IN.  Into  the  spinous  processes  of  all  the  vertebrae  of  the 
loins  and  back  and  neck,  except  the  first. 

USE.  To  support  the  spine  and  trunk. 

INTERS-FINALES  DORSI  ET  LUMBORUM,  and  the  INTER** 
TRANSVERSALES  DORSI,  are  rather  small  tendons  than  mus- 
cles, serving-  to  connect  the  spinal  and  transverse  processes. 

INTERTRANSVERSALES  LUMBORUM.  Are  four  distinct 
small  bundles  of  flesh,  which  fill  up  the  spaces  between  the 
transverse  processes  of  the  vertebrae  of  the  loins,  and  serve 
to  draw  them  towards  each  other. 

LEVATORES  COSTARUM.  Are  a  set  of  muscles,  each  of 
which  arises  from  the  extremity  of  the  transverse  process  of 
a  dorsal  vertebra,  and  is  inserted  into  the  upper  border  of  the 
lib  next  to  it. 


MUSCLES   SITUATED  ON  THE  FORE  PART  OP 
THE  VERTEBRAE  OF  THE  NECK. 

LONGUS  COLLI.  OR.  1.  The  bodies  of  the  three  superior 
vertebrae  of  the  back,  and  lowest  of  the  neck ;  2.  from  the 
transverse  processes  of  the  third,  fourth,  fifth,  and  sixth  ver- 
tebrae of  the  neck. 

IN.  The  fore  part  of  the  bodies  of  all  the  vertebrae  of  the 
neck. 

USE.  To  bend  the  neck  forwards  or  to  one  side. 

RECTUS  CAPITIS  ANTICUS  MAJOR.  OR.  The  points  of  the 
transverse  processes  of  the  third,  fourth,  fifth,  and  sixth  ver- 
tebrae of  the  neck. 

IN.  The  cuneiform  process  of  the  os  .occipitis,  a  little  be- 
fore the  condyloid  process. 

0s E.  To  bend  the  head  forwards. 


234 

RECTUS  CAPITIS  ANTICUS  MINOR.  OR.  The  fore  part  of 
the  body  of  the  atlas. 

IN.  The  root  of  the  condyloid  process  of  the  os  occipitis. 
USE.  To  nod  the  head  forwards. 

RECTUS  CAPITIS  LATERALIS.  OR.  The  point  of  the 
transverse  process  of  the  atlas. 

IN.  The  os  occipitis,  opposite  to  the  foramen  stylo-mas- 
toideum  of  the  temporal  bone. 

USE.  To  move  the  head  a  little  to  one  side. 

SCALENUS  ANTICUS.  OR.  The  transverse  processes  of 
the  fourth,  fifth,  and  sixth  vertebrae  of  the  neck. 

IN.  The  upper  side  of  the  first  rib,  near  its  cartilage. 

SCALENUS  MEDIUS.  OR.  The  transverse  processes  of  all 
the  vertebrae  of  the  neck. 

(The  nerves  to  the  superior  extremity,  pass  between  this 
muscle  and  the  former.) 

IN.  The  upper  and  outer  part  of  the  first  rib,  extending 
from  its  root  to  within  the  distance  of  an  inch  from  its  carti- 
lage. 

SCALENUS  POSTICUS.  OR.  The  transverse  processes  of 
the  fifth  and  sixth  vertebra?  of  the  neck. 

IN.  The  upper  edge  of  the  second  rib,  near  the  spine. 

These  three  muscles  bend  the  neck  to  one  side.  When 
the  neck  is  fixed,  they  elevate  the  ribs,  and  dilate  the  chest. 

LIGAMENTS  OF  THE  SPINE. 

The  ligaments  of  the  spine  should  be  examined  after  the 
muscles  are  dissected. 

All  the  vertebra?,  except  the  two  first,  (viz.  the  atlas  and 
dentata,)  are  connected  together,  nearly  in  the  same  manner. 
The  first  set  of  ligaments  to  be  dissected,  are  those  which 
may  be  easily  understood,  though,  from  their  shortness,  it 
will  be  difficult  to  show  them,  viz.  the  capsular  ligaments, 
which  bind  the  articulating  processes  together.  As  each 
vertebra  has  four  articulating  surfaces,  there  must  be  as 
many  eapsular  ligaments,  viz.  two  superior,  and  two  inferior ; 
these  will  be  sufficiently  disctinctly  seen,  when  the  vertebra? 
are  divided  from  each  other. 

If  we  remove  the  muscles  from  the  anterior  part  of  several 
of  the  bodies  of  the  vertebra?,  we  shall  see  a  dense  fascia^ 
which  may  be  traced  down  the  whole  length  of  the  fore 
part  of  the  spine ;  this  is  the  ligament  which  is  called  Ligw- 
m&rtwn  Commune  AnteriuS)  or  Fascia  Longitudinalis  JLnteri» 


235 

or; — we  may  also  see  between  the  bodies  of  the  vertebra, 
the  matter  which  is  called  Intervertebral  Substance,  and,  co- 
vering this,  cross  slips  of  ligament,  which  run  from  the  body 
of  one  vertebra  to  the  other  ;  these  are  the  Crucial  Liga- 
ments. By  dissecting  away  the  muscles  from  the  back  part 
of  a  few  of  the  vertebrae,  we  shall  see  tendinous  ligaments 
running  between  the  tips  of  the  spinous  process ;  these  are 
principally  found  in  the  vertebrae  of  tke  back  and  loins,  and 
are  called  the  Funiculi  Ligam'entosi.  Between  the  remaining 
parts  of  the  spinous  processes,  an  indistinct  membranoui 
ligament  may  be  seen,  which  is  sometimes  ••_  called  the  Mem- 
brana  Spinosa;  and  between  the  transverse  processes,  from 
the  fifth  to  the  tenth  dorsal,  we  shall  find  ligaments,  that  are 
called  Ligamenta  Processuum  Transversorwn  ;  but  both 
these,  and  the  membrana  spinosa^  are  very  little  more  than 
condensed  cellular  membrane. 

All  the  ligaments  which  have  already  been  described^ 
may  be  found  without  cutting  the  vertebrae  ;  but  before  we 
can  show  the  ligaments  which  are  situated  more  deeply,  we 
must  take  out  two  or  three  of  the  lower  dorsal,  or  lumbar 
vertebrae,  and  cut  down  the  spinal  canal,  so  as  to  separate 
the  bodies  of  the  vertebras  from  the  processes. 

Upon  the  back  part  of  the  body,  a  fascia,  or  ligament, 
will  be  found,  corresponding  to  that  which  was  seen  on  the 
fore  part ;  this  is  the  Ligamentum  Commune  Posticum,  or 
Fascia  Longitudinals  Posterior.  If  we  remove  the 
spinal  marrow  and  its  sheath  from  the  part  of  the  canal  form- 
ed by  the  processes,  and  merely  rub  the  parts  with  the  han- 
dle of  the  knife,  the  ligaments  which  run  from  the  root  of 
one  spinous  process  to  the  other,  will  be  exposed  ;  these  liga- 
ments have,  in  their  fresh  state,  a  yellowish  appearance, 
whence  the  name  of  Ligamenta  Subflava  has  been  given 
to  them,  and,  from  their  course,  the  words  Crurwn  Processu- 
um Spinosorum,  are  generally  added. 

The  ligaments  which  are  common  to  almost  all  the  verte- 
brae, may  now  be  enumerated. 

BEFORE    THE   VERTEBRAE    ARE    CUT. 

1.  Ligamenta  Capsularia. 

2. — Intervertebralia  Cartilaginea. 

[Intervertebral  substance*) 
&, Crucialia. 

4.  Ligamentum  Commune  Anterius,  or  Fascia  Longitu- 

dinalis  Anterior. 

5.  Funiculi  Ligamentosi,  or  Ligamenta  Apicinm 

cessuwn  Spinosorum. 


236 

6.  Jlfembrana  inter  Spinalis. 

7.  Ligamenta  Procesmum  Transversorwm* 

WHEN    THE    SECTION    OF    THE    VERTEBRJE    IS    MADE. 

1.  Ligamentum  Commune   Posterius,    or  Fascia  Lon~ 

gitudinalis  Posterior. 
2.  Ligamenta  Subflava  Crurum  Processuum  Spinosorum. 

The  connection  between  the  occipit,  atlas,  and  dentata. 
is  very  different  from  the  other  parts  of  the  spine.  The  cap- 
sular  ligaments  between  the  atlas  and  dentata,  are  looser 
than  between  any  of  the  other  vertebrae, — there  is  no  inter- 
vertebral  substance  between  them ;  but  the  fascia  longitudi- 
nalis  anterior  is  so  much  stronger  at  the  middle,  that  it  al- 
most forms  a  distinct  ligament.  The  atlas  it  attached  to  the 
occiput,  by  distinct  capsidar  ligaments,  surrounding  each 
condyle  ;  and  there  is  also  a  ligament  which  surrounds  the 
foramen  magnum,  and  is  connected  to  the  upper  margin  of 
the  atlas,  which,  as  it  has,  on  its  internal  aspect,  some  re- 
semblance to  a  funnel,  was  called  by  Winslow,  the  Ligamen- 
tum Infundibi/iforme.  The  middle  of  this  ligament  is 
strengthened,  on  the  anterior  part,  by  a  continuation  of  the 
fascia  Ion  gitudinalis  anterior, — and  on  the  posterior  part,  by 
a  ligament  something  similar  to  the  funiculi  ligamentosi. 
All  these  connections  may  be  seen  by  merely  dissecting 
away  the  muscular  fibres  which  cover  them ;  but  to  see 
the  deep  ligaments,  the  bones  must  be  cut  in  a  certain  man- 
ner. 

As  it  is  supposed  that  the  brain,  &c.  have  already  been 
examined,  we  should  cut  through  the  spine,  at  the  fifth  cer- 
vical vertebrae,  and  then  cut  through  the  vertebrae  longitu- 
dinally, leaving  only  the '  transverse  processes  attached  to 
their  bodies.  We  should  then  carry  the  saw  in  the  same 
line,  so  as  to  cut  through  the  occipital  bone,  immediately 
posterior  to  the  condyles  :  as  this  cut  will  also  go  through 
part  of  the  temporal  bones,  we  must  take  care  to  keep  to 
the  posterior  part  of  the  mastoid  processes,  that  we  may  not 
destroy  the  joint  of  the  jaw. 

The  first  thing  which  we  have  to  observe,  is  the  firm  at- 
tachment of  the  dura  mater  to  the  edge  of  the  foramen  mag^ 
num,  and  to  the  upper  cervical  vertebrae.  When  we  tear 
off  the  dura  mater,  we  shall  see  below  it,  a  set  of  Hgamen- 
tous  bands,  which  run  from  the  edge  of  the  foramen  rnag- 
num, — are  then  connected  to  the  upper  vertebrse,  and  appear 
to  terminate  about  the  third  or  fourth  ;  these  bands  form  the 
the  Apparatus  Ligamentosus.  We  can  now  feel  the  proceg- 


237 

fttts  dentatCrs  ;  and  by  dissecting  away  some  of  the  apparatus 
tigamentows,  we  shall  see  two  portions  of  ligament,  which 
arise  from  the  front  and  sides  of  the  process,  and  proceed 
upwards,  diverging  a  little,  to  be  attached  to  the  edge  of  the 
foramen  magnum :  these  are  generally  called  Ligamenta  La- 
ter alia,  or  mod  eratoria:  for  that  which  has  been  described  as 
a,  Perpendicular  Ligament,  is  nothing  more  than  a  few  slips 
of  membrane  which  maybe  found  between  these  two  lateral 
ligaments.  J5ut  the  principal  ligament  here,  is  that  which 
runs  across  between  the  two  tubercles  on  the  inside  of  the 
atlas  ;  it  is  called  Ligamentum  Transversaie,  and  locks  in  the 
processus  dentatus.  The  Appendices  of  this  ligament  are 
merely  its  edges,  extending  upwards  and  downwards.  The 
corresponding  surfaces  of  the  processus  dentatus,  and  of  the 
atlas,  are  connected  together  by  a  very  fine  capsular  liga- 
ment. 

There  is  some  difficulty  in  showing  these  ligaments  dis- 
tinctly. The  dissection  will  be  facilitated  by  twisting  the 
vertebr  round ; — for  then  the  ligaments  will  be  easily  dis- 
tinguished from  the  cellular  membrane  which  covers  them^ 
by  the  resistance  which  they  offer. 

LIGAMENTS  BETWEEN  THE  ATLAS  AND  OCCIPUT. 

1.  Ligamentum  Infundibiliforme. 

2.  Ligamenta  Capsularia. 

3.  Apparatus  Ligamentosus, 

BETWEEN  THE  DENTATA  AND  OCCIPUT.. 

1.  Ligamenta  Lateralia. 

2.  Ligamentum  Perpendiculare. 

BETWEEN  THE  ATLAS  AND  DENTATA, 

1.  Ligamenta  Capsularia. 

2.  Ligamentum  Transfer  sate. 

3.  — Capsulare  (of  the  process.) 

LIGAMENTS  OF  THE  JAW  BONE. 

When  the  muscles  are  dissected  away  from  below  tfee 
jaw,  the  fascia  which  connects  the  styloid  process  to  the- 
jaw,  being  necessarily  cut  through,  the  joint  will  be  much 
weakened. 

To  understand  the  structure  of  this  joint,  we  should  com- 
pare it  with  those  of  the  carnivorous  and  graminivorous  ani- 
mals.— In  the  carnivorous  animal,  as,  for  example,  ia  the 


238 

badger,  the  jaw  bone  is  locked  into  the  gleneid  cavity,  s© 
that  it  is  purely  a  simple  hinge  joint;  and  there  are  only 
short  lateral  ligaments.  In  the  graminivorous  animal  the  ca- 
vity in  the  temporal  bone  is  so  shallow,  that  much  lateral 
motion  is  allowed ;  and  the  lateral  ligaments  are  long.  The 
joint  in  the  human  bo.dy  is  of  an  intermediate  form ;  for  the 
jaw  bone  is  not  so  nicely  adapted  to  the  hollows  in  the  tem- 
poral bone, — nor  are  the  ligaments  so  short  as  in  the  carniv- 
orous animal ;  but  the  cavity  is  deeper,  aud  the  condyle  is 
rounder,  than  in  the  graminivorous  animal. 

In  the  dissection  of  the  external  part  of  the  joint,  we  shall 
find  a  ligament  running  from  the  lower  margin  of  the  zygo- 
matic  process, — this  may  be  divided  into  two  portions,  one 
of  which  runs  perpendicularly  to  the  neck,  the  other  to  the 
condyle  of  the  jaw  ;  it  is  called  Ligamentum  Laterale  Exter- 
num. 

When  we  look  on  the  inside,  we  shall  see  a  ligament  ri- 
sing from  the  edge  of  the  glenoid  fissure,  and  the  Eustochian 
tube,  and  running  to  the  jaw  bone,  midway  between  the  an- 
gle and  the  condyle  ;  this  is  the  Ligamentum  Laterale  Jnter- 
num.  Both  of  these  ligaments  are  intimately  connected  with 
the  Ligamentum  Capsufare,  which  arises  from  the  edge  of  the 
glenoid  cavity,  and  is  attached  to  the  neck  of  the  bone. 

When  we  cut  through  the  capsular  ligament,  we  shall  find 
that  the  interior  of  the  joint  is  divided  into  two  parts,  by 
an  interarticular  cartilage,  to  the  edges  of  which  the  capsu- 
lar ligament  is  attached. 


LIGAMENTS  OF  THE  RIBS. 

The  ligaments  which  attach  the  ribs  to  the  spine,  are  very 
simple.  We  may  cut  out  three  of  the  middle  vertebrae,  with 
their  corresponding  ribs,  and  then  cut  through  the  ribs,  so  as 
to  leave  only  about  three  inches  attached  to  the  spine. — 
When  the  pleura  is  torn  off,  the  head  of  each  rib  will  be  seen 
to  be  articulated  with  the  intervertebral  substance  of  two 
vertebrse.  From  the  head  of  each  rib,  we  shall  see  ligamen- 
tous  bands  running  to  the  body  of  each  vertebra,  which  are 
called  Ligamenta  Capitelli  Costantm  (sometimes  called  Lig- 
amenta Antica.)  If  we  cut/through  these  ligaments,  we  shall 
find  that  the  two  articulating  surfaces  on  the  head  of  the  rib, 
are  attached,  by  separate  Capsular  ligaments,  to  the  two 
vertebrae :  the  back  part  of  the  rib  is  also  articulated  with 
the  transverse  process,  by  a  distinct  Capsular  ligament.— 
From  the  back  part  of  the  transverse  process,  a  ligament  will 
be  found  running  to  the  tubercle  of  the  rib  ;  this  is  called 


239 

the  Ligamentum  Transversale  Extemum.  If  we  forcibly  se- 
parate the  ribs  from  each  other,  we  shall  discover  two  other 
ligaments,  which  come  from  the  transverse  processes  of  the 
vertebrae,  and  are  attached  to  the  neck  of  the  rib.  The  one 
which  is  on  the  inside,  and  which  comes  from  the  lower  part 
of  the  transverse  process  of  the  vertebra,  and  is  attached  to 
the  neck  of  the  rib.  immediately  below  it,  is  the  Ligamtntum 
Cervicis  Costaz  Intefnum.  The  other  is  on  the  back  part  :  it 
arises  from  the  root  of  the  transverse?  process, — crosses  the 
firsthand  is  inserted  into  the  upper  edge  of  the  neck  of  the 
rib ;  it  is  called  the  Ligamentum  Cervicis  Costcc  Externum.* 

MGAMENTS  BETWEEN  EACH  RIB  AND  THE  SPINE. 

1 .  Ligamentum  Capitelli  Costce,  or  Ligamentum  Ante- 

terius. 

%.  Ligamenta  Capsularia  Capitelli^ 
3.  Ligamentum  Capsulare. 

(Of  the  union  with  the  transverse  process.) 
4. Tranwersaie  Externum. 

5.  ; Cermcis  Inter  num. 

6.  — — -Externum. 

The  cartilages  of  the  seven  true  ribs,  are  united  to  the 
sternum  in  a  simple  manner  ;  and  to  show  the  connection, 
very  little  dissection  is  necessary.  The  sternal  extremities 
of  the  bony  part  of  the  rib  being  concave,  receive  the  ends  of 
the  cartilages,  which  are  convex  ;  the  other  extremity  of  each 
cartilage  isimplanted  into  the  concavities  on  the  lateral  part 
of  the  sternum.  Surrounding  each  of  these  points  of  union, 
there  are  capsular  ligaments  ;  and  the  union  to  the  sternum 
is  strengthened  by  slips  of  ligament,  running'  from  the  rib, 
upon  the  sternum  ;  these  slips  have  been  named  according  to 
the  direction  they  run  ;  those  running  immediately  from  the 
rib  to  the  sternum,  are  called  Ligamenta  Radiatim  Disjecta ; 
and  some  slips,  which  cross  from  the  cartilage  of  the  one  side 
to  that  of  the  other,  are  called  Ligamenta  Transversalia. 

Between  the' first  rib  and  the  sternum,  the  union  by  carti- 
lage is  very  complete.  The  cartilages  of  the  6th,  7th,  8th, 
and  9th,  are  connected  by  loose  capsular  ligaments,  and  by 
ligamentous  slips,  which  are  extended  between  them,  to 
keep  them  in  their  proper  position. 

*  When  the  bones  are  examined,  it  is  evident  that  the  lig- 
aments of  the  1st,  llth,  and  twelfth  ribs  must  be  different 
from  the  others,  since  they  are  each  connected  with  one  ver- 
tebra only.  There  is  no  articulation  between  the  two  last 
and  the  transverse  processes. 


240 

LIGAMENTS  BETWEEN  THE  CLAVICLES  STER- 
NUM, AND  THE  FIRST  RIB  OF  EACH  SIDE. 

The  sternum  should  be  cut  through  the  middle ;  the  clavi- 
cles and  first  ribs  should  also  be  cut,  about  the  middle. 

The  first  ligament  we  perceive,  is  that  running  between 
the  heads  of  the  two  clavicles,  across  the  sternum ;  it  is  cal- 
led Ligamentum  Interclaviculare. 

There  may  then  be  observed,  slips  of  ligament  running 
from  the  heads  of  the  clavicle,  upon  the  sternum  ;  those  on 
the  external  part,  form  the  Ligamenta  Ante^ia  ;  and  on  the 
internal  part,  the  Ligamenta  Postica.  Under  these  slips, 
there  is  a  capsular  ligament ;  but  before  examining  this  par- 
ticularly, we  should  attend  to  the  connexion  which  there  is 
between  the  clavicle  and  the  first  rib.  Between  the  upper 
part  of  the  rib,  and  the  tubercle  on  the  lower  part  of  the  cla- 
vicle, close  to  its  connexion  with  the  sternum,  a  strong  liga- 
ment will  be  seen,  which,  from  its  shape,  is  called  Ligamen- 
tum Rhomboideus. 

The  capsular  ligament  between  the  clavicle  and  sternum, 
may  now  be  opened  ;  and  then  there  will  be  seen  an  interar- 
ticufar  cartilage,  which  is  connected  to  the  sternum  and  cla- 
vicle, by  portions  of  the  capsular  ligament, — so  that  the  cap- 
eular  ligament  may  be  described  here,  as  in  the  jaw,  as  com- 
posed of  two  parts. 


DISSECTION 

OF  THE 

ARTERIES  AND  VEINS 

OF 

THE  CHEST,  NECK  AND  HEAD. 


THERE  is  no  part  more  important  to  the  student,  than  the 
aurgical  anatomy  of  these  vessels ;  but  he  must  restrain  his 
impatience,  and  be  content,  m  the  first  dissection,  to  learn 
thek  branches 


Ml 

The  injection  of  the  vessels  of  the  upper  part  of  an  adult, 
or  old  body,  is  generally  made  in  the  following-  manner : — 

An  incision  is  to  be  carried,  through  the  skin,  in  the  length 
of  the  sternum;  the  bone  is  then  to  be  cut  through,  in  the 
same  line  ;  and  the  chest  is  to  be  forcibly  opened,  by  pul- 
ling on  the  two  portions  of  the  sternum.  A  piece  of  wood, 
about  four  or  five  inches  long,  is  then  to  be  placed  between 
them.  The  pericardium  is  to  be  opened :  and  a  large  pipe 
(around  which  a  little  cloth  must  be  wrapped)  is  to  be  put 
into  the  aorta,  just  at  its  origin  from  the  ventricle.  The  de- 
scending aorta  must  be  tied,  about  opposite  to  the  fifth  dor- 
sal vertebra.  It  will  easily  be  found,  by  tearing  up  the  ad- 
hesions of  the  left  lung. 

When  an  injection  is  made,  with  the  arteries  prepared  in 
this  manner,  only  the  vessels  of  the  head  and  arms,  will  be 
filled.  Though  this  is  not  so  good  a  method  as  the  follow- 
ing, to^enable  us  to  show  the  origins  of  the  vessels  from  the 
aorta  ;  still  we  are  generally  obliged  to  do  it,  if  the  body  is 
old,  or  if  the  aorta  is  very  much  dilated.  But  when  the  sub- 
ject is  young,  and  when  we  are  not  anxious  to  preserve  the 
muscles  on  the  side  of  the  chest,  the  thorax  may  be  so  open- 
ed, that  a  pipe  may  be  put  into  the  aorta,  opposite  to  the 
sixth  dorsal  vertebra.  The  injection  must,  in  this  case,  be 
prevented  from  distending  the  ventricle,  by  an  assistant  hol- 
ding the  root  of  the  aorta  ;  for  the  valves  will  very  seldom 
prevent  the  wax  from  passing  into  the  ventricle.  If  the  in- 
jection be  allowed  to  pass  into  the  heart,  the  force,  of  the 
syringe  will  be  so  taken  off,  that  the  extreme  branches  of 
the  head  and  arms  will  not  be  filled.  The  manner  of  inject- 
ing the  heart,  &c.  for  a  preparation,  has  been  already  des- 
cribed at  page  221.  If  the  student  wishes  to  make  a  very 
minute  injection  of  wax,  of  the  arteries  of  the  head  or  arm, 
he  must  inject  each  part  separately  ;  for  when  they  are  both 
injected  at  once  from  the  aorta,  the  extreme  branches  are 
very  seldom  filled. 

In  describing  the  manner  of  dissecting  the  great  arteries, 
I  shall  suppose  that  the  injection  has  been  made  from  the 
aorta,  opposite  to  the  sixth  rib. 

Though  the  ventricle  has  not  been  filled,  the  coronary  ar- 
teries will ;  there  is  not  much  dissection  required  to  show 
them,  unless  the  heart  be  very  fat;  and  in  such  a  case,  part 
of  the  fat  should  be  removed.* 

*  The  dissection  of  the  arteries  of  the  brain  should  be 

made,  previous  to  tracing  any  of  the  arteries  of  the  chest ; 

by  which  the  student  will  have  an  opportunity  of  seeing-  tiie 

parts  of  the  brain,  which  he  in  all  probability  would  lose,  if 

W 


242 

By  raising  the  pericardium,  and  the  cellular  membrane, 
from  the  root  of  the  aorta,  the  ascending  part  of  the  Arch 
will  be  exposed  ;  and  by  cutting-  a  little  higher,  the  great 
vessels  which  pass  from  it,  would  be  seen ;  but  before  this  is 
done,  we  may  examine  some  of  the  other  vessels  of  the  heart, 
which,  though  uninjected,  may  still  be  easily  dissected.  First, 
we  may  show  the  origin  of  the  Pulmonary  Artery,  which,  as 
it  runs  under  the  aorta,  divides  into  two  great  branches, 
which  pass  into  the  lungs.  The  adhesion  which  is  so  strong 
between  the  lower  part  of  the  aorta.,  and  the  point  of  the  bif- 
urcation of  the  pulmonary  artery,  is  produced  by  the  remains 
of  the  Ductus  Anteriosus. 

On  the  right  side  of  the  ascending  aorta,  the  Descending' 
Vena  Cava  is  seen  ;  and  when  the  pericardium  is  completely 
dissected  away,  the  great  veins  which  form  it,  will  be  shown, 
viz.  the  union  of  the  Ltft  Jugular,  and  Left  Subclavian  Veins* 
which  form  a  branch,  that  passes  across,  to  unite  with  the 
Right  Subclavian,  and  Right  Jugalar  Veins.  The  Vena 
Azygos  passes  into  the  cava,  after  it  has  been  formed  by  the 
union  of  the  great  branches. 

Though  the  lesser  veins  are  not  of  much  importance,  and 
though  they  will  scarcely  be  seen,  unless  they  are  injected 
or  very  much  distended  with  blood,  still  I  shall  enumerate 
them.  The  Vena  Jlfammaria  Internet  of  the  light  side,  joins 
the  upper  part  of  the  superior  vena  cava  ;  that  of  the  left 
side  joins  the  subclavian  vein,  opposite  to  the  cartilage  of  the 
first  rib.  The  Diaphragmatica  Superior,  or  Pericardio-Di- 
aphragmatim,  on  the  right  side,  joins  the  upper  part  of  the 
vena  cava  ;  the  left  joins  the  subclavian,  below  the  mamma- 
ria.  The  Thymica,  on  the  right  side,  sometimes  joins  the 


right  side,  enters  the  root  of  the  subclavian  vein  :  on  the  left 
side,  it  joins  the  subclavian  vein,  or  the  diaphragmatica,  or 
the  mammaria  interna.  The  Thyroid  Vein,  or  Trachealis, 
or  Gutturalis  of  the  right  side,  passes  into  the  upper  part  of 
the  vena  cava  :  of  the  left  side,  into  the  upper  and  back  part 
of  the  left  subclavian.  The  distribution  of  these  veins  is 

he  were  to  leave  the  dissection  of  the  branches  of  the  inter- 
nal carotid,  until  he  has  finished  those  of  the  chest,  and  of 
the  external  carotid.  The  manner  of  dissecting  the  arteries 
of  the  brain,  is  described  a  little  farther  on. 

*The  thoracic  duct  will  not  be  seen  unless  it  has  been  filled 
from  below, — it  passes  into  the  angle  between  the  subclaviaw 
and  jugular  veins  of  the  left  side. 


243 

described  by  their  names.  It  is  for  the  most  part  very  regu- 
lar ;  but  their  communications  with  the  larger  veins  are  ve- 
ry inconstant,  and  differ  in  each  side  as  the  great  trunks  are 
different. 

The  dissection  of  the  arteries  is  now  to  be  continued.—- 
When  the  whole  of  the  pericardium  is  removed,  the  arch  of 
the  Aorta  will  be  seen,  and  arising  from  it,  the  Arteria  Innom- 
iniltfy — the  Left  Carotid  and  the  Left  Subdavian.  Before 
these  arteries  are  traced,  the  left  lung  may  be  pulled  up,  so 
that  the  Descending  Aorta  may  be  seen  ;  but  we  should  not  as 
yet  cut  away  any  of  the  ribs,  to  show  the  small  vessels  which 
arise  from  this  part  of  the  aorta. 

After  making  these  trunks  distinct,  we  should  dissect  the 
origins  of  the  sterno  cleido  mastoideus  ;  and  upon  one  side, 
(disregarding  the  relative  situation  of  the  parts,)  cut  off  two 
inches  of  the  clavicle,  and  an  inch  of  the  first  rib,  with  a 
small  portion  of  the  sternum.  But  before  we  do  this,  we 
should  look  under  the  sternum  for  the  mamaria  interna,  and 
separate  it,  so  that  we  may  preserve  it  as  a  detached  vessel. 
After  having  made  these  cuts,  which  of  course  must  be  done 
carefully,  a  groat  many  branches  will  be  exposed.  The 
principal  ones  will  be  found  to  come  from  the  subsdlavian  ; 
for  if  we  dissect  between  the  larynx  and  the  sterno  cleido 
mastoideus  muscle,  we  shall  .find  that  the  commojl  carotid 
runs  for  a  considerable  distance  before  it  gives  off  any  branch- 
es. 

The  dissection  of  the  branches  from  the  subclavian  must, 
therefore,  be  first  attended  to. 

We  cannot  avoid  seeing  the  Jffammaria  Internet,,  which 
passes  down  on  the  inside  of  the  sternum  ;  and  if  we  look  im- 
mediately opposite  to  it,  we  shall  find  the  Vertebral  rising 
from  the  upper  part  of  the  artery.  These  two  branches  are 
very  regular ;  but  all  the  others  are  so  much  the  reverse, 
that  the  description  which  I  shall  now  give,  will  in  all  proba- 
bility not  correspond  with  the  vessels  which  are  seen  in  the 
first  dissection.  Close  by  the  origin  of  the  mammaria  inter- 
na,  we  shall  probably  find  a  large  trunk,  which  may  be  tra- 
ced towards  the  larynx,  and  under  the  carotid  ;  this  will  be 
the  Inferior  Thyroid.  From  the  same  source,  and  perhaps 
in  union  with  it,  another  branch  may  be  seen  crossing  the 
upper  part  of  the  neck  :  this  last  vessel  is  to  be  carefully  fol- 
lowed,-—for  if  it  is  small,  it  will  be  distributed  on  the  muscles 
of  the  neck  only,  and  be  called  the  TransvcrsalisColli  ;  but 
if  it  be  large,  it  may  then  be  traced  over  the  scapula,  and 
thence  be  called  the  Supra  Scapularis. 

Tkere  is  generally  another  branch  found  here,  which  pai~ 


244 

*es  from  the  same  trunk,  in  the  clavicle.  It  is  called  the 
Transversali^  Hwneri. 

As  these  vessels  are  very  irregular  in  their  order  of  coming 
off  from  the  subclavian,  we  must,  in  describing-  them,  give 
the  name  to  the  branches,  and  tracing  them  back,  apply  it 
it  to  the  trunk  from  which  they  arise. 

If  we  now  trace  the  subclavian  a  little  farther,  we  shall  sec 
some  small  branches  lying  upon  the  scalenus  :  these  some- 
times arise  in  a  distinct  trunk,  which  is  called  Cervical  is  Su- 
perficmlis,  but  this  is  very  frequently  a  branch  of  the  trans- 
versalis  colli : — Cervicalis  Profunda  is  the  name  which  is 
given  to  the  artery  that  rises  from  the  subclavian,  while  it  is- 
passing  under  the  scalenus  anticus. 

When  the  subclavian  has  passed  about  half  an  inch  beyond 
the  scalenus  anticus,  we  shall  find  that  if  the  transversalis 
colli  has  been  small,  that  a  large  branch  will  be  given  off  at 
this  point,  and  which,  as  it  passes  to  the  scapula,  is  called  the 
Scapu/aris,  or  Dorsalis  Scapula?.  The  student  must  not  call 
this  description  incorrect,  if  he  does  not  find  it  correspond 
with  the  arrangement  of  the  vessels  which  he  discovers  in 
the  first  body  which  he  dissects, — for  he  will,  in  the  course 
of  his  studies,  find  that  the  order  of  the  branches  of  the  sub- 
clavian is  exceedingly  irregular. 

The  description  has  hitherto  been  taken  from  the  left  side 
of  the  body.  The  manner  in  which  the  small  vessels  branch 
off,  is  not  very  different  in  the  two  sides  ;  but  there  is  a  most 
material  difference  in  the  relative  position  of  the  great 
trunks,  on  the  right  and  left  side :  this  should  be  particular- 
ly noticed  in  making  the  surgical  dissection. 

As  we  have  already  loosened  the  attachments  of  the  ster- 
no  cleido  muscle,  by  cutting  through  the  sternum  and  clavi- 
cle, we  may  now  lay  it  a  little  to  one  side.  We  shall  then 
see  the  great  Jugular  Vein,  lying  almost  over  the  artery, 
and  the  great  nerve,  the  Par  Vaguin^  by  the  side  of  it ;  but 
at  present  we  need  not  attend  particu]arly  to  these  parts,  but 
pull  them  to  one  side,  and  then  trace  the  common  carotid, 
with  the  foreceps  and  scissars,  from  its  origin,  on  the  left 
side,  from  the  arch  of  the  aorta. 

The  artery  will  be  found  to  pass  up  by  the  side  of  the 
larynx,  for  three  or  four  inches,  without  giving  off  any  branch- 
es :  here  it  is  called  the  Common  Carotid.  It  at  once  di- 
vides into  two  great  trunks,  which  are  called  the  External  and 
Internal  Carotids.  The  internal  will  afterwards  be  found 
to  pass  to  the  foramen  caroticum  of  the  temporal  bone  without 
giving  off  a  branch.  Hence  all  the  branches  which  we  have 
to  trace  among  the  muscles  of  the  throat,  and  on  the  faoe 
and  temples,  mvist  be  from  the  external  carotid, 


245 

The  first  branch  which  we  shall  find  rising  from  the  Exter- 
nal Cf.:r<>tul*  is  the  Superior  Thyroifl  this  we  ir,\\vt  trace 
downwards,  tow'rds  the  thyroid  gland,  m  whirh  we  hhali 
find  it  distributed,  and  uniting1  its  branches  with  those  of  the 
Inferior  Thyroid,  which  we  have  already  seen  coming  fr»  ni 
the  subclavian.  The  next  branch  which. is  given  of,  is  the 
Linf^unlis :  we  may  trace  this  along  the  line  of  the  cshyoides 
to  the  muscles  of  the  tongue,  where  it  divides  into  several 
branches  :  but  before  we  can  trace  these  fully  out,  we  i:  i^  ; 
follow  some  of  those  of  the  next  artery, — the  Faci/.iis,  or 
External  Maxillary,  This  comes  off  very  often  in  the  same 
trunk  with  the  lingualis,  and  if  not,  it  rises  immediately  af- 
ter it.  It  runs  first  towards  the  lower  part  of  the  jaw,  and 
under  the  muscles.  (But  as  both  this  and  the  lingualis  are 
covered  by  the  digastricus 'and  stylo  hyoideus,  it  will  be  neces- 
sary to  make  a  neat  elk-section  of  the.  muscles,  before  we  can 
trace  them  farther.)  After  the  facial  emerges  from  under 
the  muscles,  it  passes  into  the  substance  cf  the  snbmaxillary 
gland,  through  which  the  branches  must  be  carefully  traced*: 
from  these,  one  branch  will  be  seen  to  pa.^s  on  the  anf  • 
part  of  the  mylo  hyoideus  ;  this  i-  the  submentafis.  The 
trunk  of  the  artery,  alter  pacing  through  the  submaxiliary 
gland,  turns  over  the  jaw,  to  be  distributed  upon  the  face  ;— 
but,  the  branches  which  pass  to  the  face  should  not  be  dissect- 
ed until  some  of  those  below  the  jaw  have  been  traced. 

The  submaxillary  gland  should  now  be  rahed  ; — the  lin- 
gualis may  then  be  traced  under  the  thyreo  hyoideus  mus- 
ele,  sending  its  branches  among  the  muscles  of  tlit -.  toinrrr. 
which  can  all  be  easily  followed  if  we  have  already  made 
ourselves  master  of  the  muscles  of  the  tongue.  Alter  having1 
traced  the  lingua"  artery  to  <-c  me  depth,  it  will  be  found  to 
divide  into  two  principal  branches,  which  are  the  arltria  dor- 
sal Is  lingvce,  running  towards  the  root,  and  the  rfminft,  run- 
ning to  the  tip  of  the  tongue,  I  ,-hall  not  here  give  ihe 
names  of  the  smaller  branches  of  the  thyroid,  facial,  and  lin- 
gual, but  refer  to  the  next  //•;/,/>. 

To  prosecute  the  dissection   farther,  we  should  carefully 
raise  the  skin  from  over  the  outer  part  of  the  mnssele: 
wards  the  i.ube  of  the  ear,  and  continue  the  dissection  of 
rouri ilthe  bock  of  ihe  ear,  and  over  the  insertion  of  the  .)/V.v- 
'ti  and   Trdppzius.     In  removing  the  skin  from  the  iwus- 
seter,  we  must  take  care  that,  we  do  not  cut  the  Trunwrsu- 
/>'>•  Fueled  which  lies  immediately  under  the  skin,  and  gene- 
rally in  a  line  with  the  middle  of  the  tube  of  the  ear.     Some 
small  branches  of  the  facial,   which  are  called  mawtf 
\vill  also  be  seen  upon  the  masseter.     In  removing  the  ^kin 
fiorn  the  back  of  the  ear,  we  must  avoid  cutting  the  branch* 


246 

we  of  the  Posterior  Jluris,  which  are  very  superficial.  Tiie- 
lame  care  is  also  to  be  taken  in  dissecting  towards  the  occi- 
put, as  many  of  the  superficial  branches  of  the  Occipital  pass 
ever  the  Jtfastouleus  and  Trapezius. 

The  Parotid  Gland  will  now  be  exposed  ;  but  before  we 
trace  the  branches  through  it,  we  should  examine  the  trunks 
of  those  branches  which  are  seen  on  the  occiput  and  ear. 

Three  arteries  generally  rise  from  the  carotid,  before  it 
enters  into  the  substance  of  the  gland,  viz.  the  Occipital,  the 
Posterior  A  iris,  and  the  Pk&ryngea  Inferior.  The  occipital 
arid  posterior  auris  very  often  come  off  in  one  tiunk,—  and  if 
not.  they  come  close  together,  and  immediately  at  the  outer 
edge  of  the  digastricus  and  stylo  hyoideus.  The  posterior 
auris  may  be  traced  first,  as  it  runs  superficially  towards  the 
back  of  the  ear.  The  occipital  will  be  found  to  run  so  deep 
under  the  insertion  of  the  sterno  cleido  mastoideus,  that,  to 
trace  it  fully,  we  shall  be  obliged  to  dissect  through  the  sub- 
stance of  mis  muscle  ;—  we  shall  then  find  its  branches  be- 
coming superficial,  some  of  which  pass  to  the  scalp,  and  oth- 
ers run  to  supply  the  superficial  muscles  of  the  back.  The 
pharyngea  inferior  is  not  unfrequently  the  second  branch 
that  arises  from  the  external  carotid  ;  but,  as  it  rises  from 
the  back  part  of  the  artery,  it  cannot  be  conveniently  seen 
until  the  branches  which  have  already  been  described,  are 
partially  dissected,  —  and  even  in  this  stage,  its  trunk  only 
can  be  seen  :  the  branches  will  be  seen  after  those  under  the 
jaw  are  dissected. 

The  trunk  of  the  carotid  is  now  to  be  traced  into  the  par- 
otid gland:  while  here,  it  gives  off  a  number  of  small 
branches,  which  are  to  be  exposed  by  carefully  cutting  away 
the  substance  of  the  gland.  The  larger  branches,  which 
are  very  superficial,  should  then  be  traced,  viz.  the  Tempo- 
ral and  the  Transversalis  Fwiei.  These  are  so  immediately 
under  the  skin,  that  there  can  be  no  difficulty  in  finding 
them, 

After  exposing  these  branches,  we  may  return  to  the  dis- 
section of  the  arteries  of  the  face,  —  for  which  there  is  no 
farther  rule  necessary,  than  merely  to  follow  them  from 
trunk  to  branch,  with  the  scissors  and  forceps.—  -The  names 
of  the  small  branches  will  be  found  in  the  Table. 

Many  of  these  branches  must  now  be  destroyed,  that  we 
may  show  the  arteries  which  pass  into  the  deep  parts  of  the 
face,*  and  particularly  the  branches  of  the  Maxillaris  In- 


*  Nearly  the  same  rules  should  be  followed  in  making  a 
of  the  arteries  of  the  heud.     The  superficial  ar- 


247 

The  dissection  of  the  branches  of  this  artery  is  very  diffi- 
cult ;  for  we  must  not  only  cut  through  the  greater  number 
of  the  muscles  on  the  side  of  the  face,  but  we  must  also  re- 
move the  greater  part  of  the  jaw. 

The  first  thing  we  should  do,  is  to  expose  the  trunk  of  the 
external  carotid,  until  the  internal  maxillary  is  seen  going 
off  from  it, — which  it  generally  does,  opposite  to  the  lobe  of 
the  ear.  The  artery  is  then  to  be  traced  &s  far  as  possible 
under  the  jaw.  After  which,  the  jaw  bone  is  to  be  cut 
through,  just  at  the  point  where  the  facial  artery  passes  over 
it  (in  doing  this,  we  should,  of  course,  take  care  not  to  in- 
jure the  arteries  of  the  neck.)  We  may  then  cut  through 
the  insertion  of  the  pterygoidetis  interims^  after  which,  trie 
knife  is  to  be  carried  close  upon  the  inside  of  the  bone,  so  as 
to  separate  the  buccinator  and  the  membrane  of  the  mouth 
from  it.  When  this  is  done,  we  shall  be  enabled  to  pull  the 
jaw  aside,  so  as  to  enable  us  to  trace  the  trunk  a  little  far- 
ther, and  perhaps  to  see  its  first  principal  branch,  viz.  the 
dental  artery,  which  passes  into  the  lower  jaw  ; — but  in  a 
first  dissection,  this  vessel  is  to  be  sacrificed,* — for  the  whole 
of  the  side  of  the  jaw  should  be  removed ;  but  to  do  this 
safely,  and  at  the  same  time  to  enable  us  to  expose  all  the 
branches  of  the  maxilaris  interim,  we  must  also  remove  the 
whole  of  the  os  malse,  and  zygomatic  process  of  the  tempo- 
ral bone.  This  may  be  done,  by  first  cutting  with  the  sa\v 
through  the  maxillary  and  frontal  process  of  the  os  matae, 
and  the  root  of  the  zygomatic  process  ; — and  then,  with  a 
blow  of  the  chisel  and  hammer,  the  parts  will  be  so  loosened,, 
that  they  may  be  easily  dissected  off.  The  insertion  of  the 
temporalis  should  be  cut  from  the  coronoid  process  of  the 
jaw;  and  by  then  merely  cutting  close  upon  the  bone,  and 
using  a  little  force,  we  may  remove  the  whole  of  the  remain- 
ing part  of  the  jaw. 

When  the  bones  are  removed,  the  parts  will  appear  in 
great  confusion,  as  the  arteries  are  buried  in  the  temporal 
muscle,  and  part  of  the  two  pterygoid ;  but,  as  \ve  have  no 
object  now  in  preserving  these  muscles,  we  should  trace  the 
branches  of  the  great  artery  through  their  substance,  with- 
out fearing  to  sacrifice  their  fibres  :  indeed,  to  make  the 

teries  should  be  preserved  on  one  side, — and  on  the  other., 
they  should  be  removed,  so  that  the  deep  ones  may  be  exhi- 
bited. 

*  In  making  a  preparation,  we  may  preserve  the  dental  ILT 
tery,  by  leaving  a  small  portion  of  the  jaw. 


248 

branches  distinct,  we  shall  at  last  be  obliged  to  cut  the  mus- 
cular fibres  entirely  away. 

The  first  branch  that  comes  off  from  the  internal  maxilla- 
ry, is  one  of  little  consequence, — but  the  next,  L-  of  the 
greatest  importance,  the  JWeningea  Media, — for  this  is  the 
vessel  which  supplies  the  principal  part  of  the  dura  mater  : 
it  may  be  traced  into  the  foramen  spinale  of  the  sphenoid 
bone.  The  next  set  of  branches  will  be  found  passing 
through  the  substance  of  the  pterygoid  muscles. — We  shall 
then  see  the  stump  of  the  small  branch  which  passes  into 
the  spinal  hole,  to  supply  the  teeth,  viz.  the  dental,  or  infe- 
rior marUlary.  The'next  branch  is,  the  tempo-rails  -i>r< fun- 
da,  or  media,  which  passes  into  the  substance  of  the  tempo- 
ral muscle,  and  runs  close  on  the  bone. 

The  main  trunk  of  the  maxillary  now  becomes  so  crooked, 
that  we  shall  be  in  danger  of  cutting  it  through,  if  we  are 
not  very  cautious.  It  will  be  found  lying  on  the  back  part 
of  the  superior  maxillary  bone  ; — and  here  it  gives  off  some 
small  branches,  which  are  called  alveolares  superiores,  as 
they  pass  to  the  teeth  of  the  upper  jaw. 

The  trunk  now  becomes  exceedingly  difficult  to  follow  ; 
for.it  passes  into  the  spheno  palatino  figure.  From  ihis 
part  o  le  branch  may  be  traced  into  the  orbit,  which  we 
shall  afterwards  find,  passes  through  the  infra  orbital  canal, 
with  the  infra,  orbital  nerve,  to  the  upper  part  of  the  supe- 
rior maxillary  bone,  where  it  inosculates  with  the  branches 
of  the  facial;  this  artery  is  generally  called  the  Infra  Orbi- 
tal. The  next  branch  is  also  very  "difficult  to  follow  ;  for  it 
passes  at  first  directly  .downwards,  through  the  palatine  fis- 
sure, into  the  palatine  foramen, — from  which,  it  sends  i-ne 
branch  back  to  the  velum  and  a  larger  to  the  anterior  part 
of  the  palate  :  this  last  branch,  the  Pahdina,  may  be  con- 
sidered as  the  extremity  of  the  internal  maxillary  artery. 
Tnere  are,  however,  still  two  branches  to  be  enumeratd  : 
first  one  which  creeps  by  the  side  of  the  external  pterygoid 
pr  >cr^s,  aii-1  is  distributed  on  the  upper  part  of  the  pharvnx, 
and.  is  called  the  superior  p:>ar//n.^eal  •  while  another  runs 
into  the  back  oart  of  the  nostril,  through  the  spheuo  palatine 
hole,  and  is  called  the  nana'  :  this  is  distributed  on  the  lower 
part  of  the  nostrils;  and  from  it,  a  branch  may  often  be 
triced.,  along  the  lower  part,  to  the  foramen  incisivum,  to 
inosculate  with  the  palatine. 

I  have  been  a  little  more  minute  in  tho  description  of  this 
artery*  than  that  of  the  others,  for  it  is  one  particularly  diffi- 
cult to  follow ;  indeed,  in  order  to  see  the  branches  of  it  dis- 
tinctly, we  must  sacrifice  every  other  pare.  The  student, 
while  dissecting  this  artery,  should  have  the  basis  of  the  scull 


249 

constantly  before  him,  to  enable  him  to  understand  the  differ- 
ent twists  of  the  artery. 

We  should  now  turn  our  attention  to  the  internal  carotid. 
This  artery  will  appear,  at  the  bifurcation,  to  be  more  exter- 
nal than  the  external  carotid  ;  but  it  almost  immediately  be- 
comes more  internal^  and  passes  deep  under  the  parotid 
gland,  and  there  it  is  covered  by  the  great  nerve,  and  lies 
elose  upon  the  rectus  capitis  anterior.  vVe  then  lose  it ;  for 
it  passes  into  the  foramen  caroticum  of  the  temporal  bone. 
During  its  whole  course,  we  shall  find  no  branches  rising 
from  it,  except  some  very  small  ones,  to  the  nerves  and  to 
the  Eustachian  tube. 

The  internal  carotid  must  now  be  followed  through  the 
bone.  This  may  be  done,  and  the  branches  of  the  maxilla- 
ris  interim  be  still  preserved :  but  we  must  entirely  change 
our  plan  of  dissection. 

If  we  wish  merely  to  gain  a  knowledge  of  the  course  of 
the  internal  carotid,  through  the  brain,  we  may  remove  the 
scull-cap,  arid  proceed  to  the  dissection  of  the  brain.*  It  is 
presumed,  that  the  student  has  already  a  general  knowledge 
of  the  parts  of  the  brain.  On  raising  the  scull-cap,  which 
is  to  be  done  in  the  manner  recommended  for  examining  the 
brain,  at  p.  160,  the  vessels  of  the  dura  mater  will  be  the 
first  that  will  strike  the  eye.  Those  on  the  part  opposite  to 
the  frontal  bone,  may  belong  to  the  anler-ivr  m&*ing&Lli 
which  rises  from  the  Ophthalndca  ;  but  this  artery  is  so  small, 
that  the  large  vessel,  the  Meningea  Media,  which  will  be 
seen  under  the  parietal  bone,  generally  gives  off  all  the 

*  T  have,  in  a  note  at  page  241,  said,  that  the  dissection  of 
the  branches  of  the  internal  carotid  should  be  made,  before 
any  of  the  others,  in  &  .first  dissection;  but  if  the  student 
wishes  to  make  a  preparation  of  the  arteries  of  the  brain,  it 
will  be  better  to  delay  the  dissection  of  them  until  all  the 
others  are  finished,  for  then,  (the  brain  being  putrid,)  the 
branches  of  the  internal  carotid  may  be  exposed,  by  merely 
washing  away  the  pulpy  matter  of  the  brain  ; — in  this  in- 
stance, "the  scull  should  not  be  opened  in  the  common  man- 
ner, rut  a  cut  should  be  made  through  the  frontal  and  parie- 
tal bones,  in  the  line  of  the  falx,  but  a  little  to  one  side  of  it. 
This  incision  may  extend  from  above  the  orbit,  to  the  tuber- 
cle of  the  occipital  bone.  Another  cut  may  then  be  made, 
above  the  level  of  the  ear,  to  meet  the  two  extremities  of  the 
first:  the  intermediate  portion  of  bone  is  then  to  be  entirely 
removed.  By  this,  we  shall  have  an  opportunity,  when  the 
pulpy  matter  is  washed  away,  of  showing  the  prolongations 
®f  the  dura  mater. 


250 

branches  that  are  seen  in  the  first  view.  The  meningea  me- 
dia may  afterwards  be  traced  back  to  the  foramen  spinale  of 
the  sphenoid  bone  through  which  it  comes  from  the  maxil- 
laris  interna.  Some  small  twigs  from  the  posterior  mmin- 
geal  may  be  seen,  hut  these  are  seldom  apparent,  until  the 
tentorium  is  raised.  The  dura  mater  may  now  be  cut 
through,  along  the  line  of  the  longitudinal  sinus,  and  oh  one 
side  only,  at  present,  so  that  the  falx  may  be  left  entire. 
The  dura  mater  i«  then  to  be  folded  over,  towards  the  tem- 
ple. The  vessels  on  the  surface  of  the  brain  will  now  be 
seen  in  great  numbers ;  they  arise  from  several  sources, 
which  will  be  discovered,  as  the  dissection  is  continued,  to- 
wards the  base. 

The  first  arteries  (which  have  distinct  names)  that  can  be 
seen,  will  be  those  of  the  corpus  callosum ; — the  artery  of 
each  side  may  be  shown,  by  merely  pulling  the  hemisphere 
separate  from  the  falx. 

After  taking  this  view,  we  may  cut  the  dura  mater  which 
covers  the  opposite  hemisphere.  We  should  then  separate 
the  falx  from  its  connexion  to  the  crista  galli ,  and  throw  it 
backwards  towards  the  tentorium  ;  and  now  we  can  sepa- 
rate the  hemispheres,  so  as  to  have  a  better  view  of  the  ar- 
teries of  the  corpus  callosum.  The  whole  of  each  hemis- 
phere is  then  to  be  cut  down  to  the  level  of  the  corpus  callo- 
sum j  for  it  is  needless  to  attempt  to  trace  the  arteries  which 
we  see  on  the  surface,  down  to  their  trunks,  as  they  form  a 
complete  net- work  in  the  substance  of  the  brain,  which  net- 
work is  supported  by  the  pia  marer.  We  may  judge  of  the 
number  of  these  vessels,  by  allowing  a  stream  of  water  to 
play  upon  the  mass  which  has  been  removed  ;  for  this  will 
wash  away  the  pulp,  leaving  only  the  membrane  and  vessels. 
By  now  separating  the  two  anterior  lobes,  we  may  trace  the 
arteries  of  the  corpus  callosum  towards  a  trunk,  which  we 
shall  afterwards  find  to  be  the  Anterior  Cerebri.  We  may 
then  open  the  ventricles,  and  we  shall  see  the  choroid  plexus 
loaded  with  the  vessels,  which  are  to  supply  the  most  inter- 
nal parts  of  the  brain. 

We  oaust  now  examine  the  other  brandies,  by  raising  the 
brain  from  the  scull.  In  lifting  up  the  anterior  lobes,  we 
shall  see  the  optic  nerves;  and  by  the  side  of  them,  the 
trunk?  of  the  internal  carotids.  These  must  be  cut  across, 
but  we  should  leave  enough  of  each  artery  to  show  the  ori- 
gin of  the  Opkthalmica,  which  passes  into  the  orbit.  The 
several  nerves  are  to  be  cut  through,  as  we  carry  the  brain 
back.  The  tentorium  is  to  be  divided,  by  carrying  the  knife 
along  the  line  of  the  petrous  portion  pf  the  temporal  bone. 


251 

The  two  Vertebral  arteries  will  then  be  seen,*  coming  up 
from  the  vertebral  canal.  When  these,  and  the  upper  part 
of  the  spinal  marrow  are  cut  through,  the  whole  mass  of  the 
brain  may  be  lifted  out.  The  vessels  may  be  seen  on  the 
base,  without  any  dissection,  but  they  will  be  made  more  dis- 
tinct, by  removing  the  tunica  arachnoides.  The  enumera- 
tion which  is  given  in  the  table  will  be  a  sufficient  description 
of  them. 


TABLE  OF  THE  ARTERIES  IN  THE  THORAX, 
AND  OF  THE  NECK  AND  HEAD.. 

AORTA. 

Anterior  to  the  Arch — CORONARIA  DEXTRA  and  CORONARIA 
IINISTRA. 

From  the  Arch — INNOMINATA,  divided  into  CAROTIS 

DEXTRA  and  SUBCLAVIA  DEXTRA  :  CAROTIS  SINISTRA  and 
SUBCLAVIA  SIMSTRA. 

From  the  descending  Aorta — a  series  of  small  arteries,  viz. 

PERICARPIACA  POSTERIOR;  PER1CARDIACA  INFERIOR;  BRON- 
CHIALIS  DEXTRA  ;  BRONCHIALIS  SINISTRA  ;  CESOPHAGEJE  ;  IN- 
TERCOSTALES  AORTFCJE. 

From  the  SUBCLAVIAN,  the  principal  or  primary 
branches  are :  I*  MAM  MARIA  INTERN  A  ;  II.  TH  YROIDE  A  IN- 
FERIOR ;  III.  INTERCOSTAJLIS  ;  IV.  VERTEBRALIS  ;  V.  CER- 

VICALIS  PROFUNDA  ;    VI.    CERVICALIS  SuPERFICIALIS. 

I.  MAMMARIA  INTERNA  gives  these  branches  :— -1.  Thyroi- 

dece  ;  2.  Comes  JVervi  Phrenici;  3.  Pericardiaca  ;  4. 
JWcdiastince  ;  5.  JMammarice  ;  6.  Epigastrica  Anastor 
moiica. 

II.  THVROIDEA  INFERIOR  generally  sonds  off — 1.   Transver- 

salis  Humeri  ;  2.  Transversalis  Colli  (either  this  or  the 

*  These  arteries  are  very  difficult  to  trace  from  their  ora- 
gin  from  the  subclavain,  as  the  greater  part  of  their  course  is 
through  the  canal  which  is  formed  in  the  transverse  processes 
of  the  cervical  vertebra.  The  spaces  between  the  vertebrae 
should  be  cleared  of  the  muscles,  &c.  to  allow  of  the  artery 
being  seen ;  or  the  processesses  may  be  cut  through.  Sev- 
eral branches  will  be  found  passing  oft  from  the  artery,  in  it* 
passage  upwards,  which  are  enumerated  in  the  Talie.  We 
must  be  careful,  in  desecting  between  the  atlas  and  the  occi- 
put, as  the  artery  bulges  out  so,  between  these  bones,  that  it. 
is  very  liable  to  be  cut. 


2-52 

last  branch  gives  off  the  scapulari*,  though  it  is  often 
a  principal  branch  of  the  subclavian  ;  it  then  rises  be* 
low  thescalemis;)  3.  Thyroidea  Ascendens  ;  4.  Thy- 
roidea Propria. 

III.  INTERCOSTALIS  :  its  branches  pass  irregularly  to  the  two 

superior  intercostal  spaces, — to  the  scalenus  and  oeso- 
phagus. Some  branches  pass  to  the  muscles  of  the 
back. 

IV.  The    Fertebralis,  principally  to  the  back  part  of  the 

brain  ;  but  it  also  gives — 1.  a  class  of  small  branches 
to  the  muscles  attached  to  the  cervical  vertebrse  ;  2. 
to  the  theca  and  spinal  marrow;  3.  to  the  muscles 
under  the  occiput;  4.  within  the  scull,  to  the  dura 
mater,  viz.  Meningeaz  Posterior  es  :  5.  Inferior  Cere- 
belli  ;  6.  Spinalis  ^Posterior  ;  7.  Spinalis  Anterior. — 
The  two  vertebral  then  unite  and  form  the  Basilar. 
From  the  basilar  there  are— 1.  branches  to  the  Me- 
dulla Oblongata,  &c.  2.  Prqfunda,  or  Posterior  Cere« 
bri  ;  3.  Arteriw  Communwanies  (uniting  with  those  of 
the  carotid,  to  form  the  Circle  of  Willis.) 

V.  CERVICAL  is  PROFUNDA  ;  gives  branches  to  the  Scaleni 

and  Longus  Colli. 

VI.  CERVICALIS   SUPERFICIALIS  ;    passes  to   the  Brachial 

plexus,  Scaleni,  Trapezm-s,  &c. 

COMMON  CAROTID  divides  into  EXTERNAL  and 
IK  TEftNAL ;  from  the  EXTERNAL,  the  principal  branch- 
es are:  I.  TKYROIDEA  SUPF.RIOH;  II.  LIJSGUALIS  ;  III. 
FACIALIS  ;  IV.  PHARYNGEA  ASCENDENS;  V.  OCCIPITALIS; 
VI.  AURICULAR.IS  POSTERIOR  ;  VII.  TEMPORALIS  ;  VIII. 
MAX  ILL  A  nis  INTERN  A.* 

I*  THYROIDEA  SUPERIOR  gives  off:    1.  thyroidea  propria ; 
2.  laryngea,  to  the  epiglottis,  and  muscles  of  the  ary-  • 
tenoicfcartOage.     Superricialismusculares,  viz.  to  the 
sternocleido  mastoideus,  to  the  sternoliyoidei  and  thy* 
roidei,  to  the  thyreo-hyoideus. 

II.  LINGUALIS.  1.  Sublingualis ;  2.  dorsalis  linguae;  3. 
ranina ;  4.  irregularly  to  the  muscles  of  the  tongue 
and  pharynx. f 

*  The  arrangement  of  the  branches  of  the  external  caro- 
tid is  very  simple.  We  have  only  to  recollect  the  parts 
which  it  passes,  and  then  We  shall  have  the  names  of  the  ar- 
teries. Thus,  it  passes  the  tlyroid  gland  ;  the  tongue  ;  the 

face ;  the  pharynx  ;  the  occiput ;  the   ear  ;  the  inside  of  the 

jaw,  and  the  temple. 

f  These  vessels  may  be  divided  into  three  sets,  of  compa- 


253 

1&.  FACIALIS.  I.  Palatina  ascendens;  2.  to  the  glands  and 
muscles  of  the  tongue ;  3.  to  the  submaxillary  glands 
and  the  tonsilaris  ;  4.  submentalis  ;  5.  to  the  masse- 
ter  and  buccinator  6.  coronaria  labii  inferioris ;  7. 
coronaria  labii  superioris  ;  l  nasalis  lateralis  ;  a  an- 
gularis. 

IV.  PHARYNGEA  ASCENDENS.     1.  Three  internal  pharyn- 

gese  ;  2.  Three  posterior  to  the  muscles,  to  the  sym- 
pathetic nerve  and  jugular  vein,  to  the  glands;  enters 
the  foramen  lacerum  posterius. 

V.  OCCIPITALIS.     1.  To  the  digastricus,  stylo  hyoideus,  and 

sterno  cleido  mastoideus  ;  2.  meningea,  viz.  with  the 
jugiilar  vein  through  the  foramen;  3.  cervicalis  de- 
scendens  ;  an  internal  branch  inosculates  with  the 
vertebralis ;  4.  auricularis  ;  5.  occipitalis  ascendens. 
The  foramen  mastoideum  posterius  receives  a  branch 
to  the  dura 'mater. 

VI.  AURICULARIS   POSTERIOR.     1.  Branches  to  the  parotid 

gland,  biventer,  and  mastoid  muscles ;  2.  to  the  mea- 
tus  extern  us,  and  membrane  of  the  tympanum  ;  3. 
stylomastoidea,  entering  the  tympanum,  supplying 
the  parts  there  and  the  mastoid  cells  ;  4.  ascending 
behind  the  ear  to  its  muscles  and  cartilages ;  5.  as- 
cending on  the  temple. 

VII.  TEMPORALIS.  1.  A  small  deep  branch,  and  a  branch 

to  the  masseter  ;  2.  transversalis  faciei, — comes  duc- 
tus  saliv® :  3.  temporalis  media  profunda ;  4.  auricula- 
res  anteriores :  5.  temporalis  anterior,  or  frontalis ;  6. 
temporalis  posterior,  or  occipitalis. 

VIII.  MAXILLARIS   INTKRTVA,  (being  in   the   order  of  the 
branching.)     1.  Auricularis,  prcfunda   and  tympani- 
ca ;  2.  meningea  media;  3.  meningea  parva,   viz.  to 
the  pterygoicl  muscles,  and  finally  piercing  the  foramen 
ovale ;  4.  maxillaris  inferior  ;  5.  temporales  profun- 
dfie  maxillares,  pterygoideae,  and  buccales  ;  6.  alveo- 
laris  ;  7.    infra  orbftalis;  8.  palatina  maxillaris:    9. 
pharyngea  superior ;  10.  nasalis. 

rative  importance  in  a  surgical  point  of  view.  In  the  rirst 
set  there  are,  the  one  to  the  thyroid  gland,  that  to  the  tongue 
and  the  artery  to  the  face.  In  the  second  set, — the  one  to 
the  inside  of  the  jaw,  arid  those  to  the  temple.  The  next 
set  is  of  very  little  importance,  as  they  lie  deep,  and  are  very 
small ;  viz.  those  to  tiie  pharynx,  occiput,  and  ear. 


254 


INTERNAL  CAROTID. 

I.  While  in  its  transit  through  the  bones,  these  branches; 

to  the  pterygoid  canal  and  cavity  of  the  tympanium  ; 
to  the  cavernous  sinus  and  pituitary  canal ;  to  the 
fourth,  fifth,  and  sixth  pairs  of  nerves  ;  to  the  dura 
mater. 

(Within  the  cranium,  and  having  emerged  from  the  dura 
mater.) 

II.  OPHTHALMICA  CEREBRALIS.     Passing  into  the  orbit  by 

the  foramen  opticum,  gives  these  branches  :  1.  to  the 
dura  mater  and  sinus ;  2.  lachrymalis,  which  goes  to 
the  gland,,  after  giving  many  branches  to  the  perios- 
teum, optic  nerve,  &c.  ?.  ciliares" — three  or  four  ar- 
teries dignified  with  the  distinction  of  inferiores,  an- 
teriores,  breves,  longiorts  ;  4.  supra  erbitalis  ;  5.  cen- 
tralis  retinae ;  6.  ethmoidales  ;  7.  palpebrales  ;  8.  na- 
'salis  ;  9.  frontalis. 

III.  SEVERAL  LESSER  BRANCHES  TO  THE  PITUITARY  GLAND, 

OPTIC  NERVE,  INFUNDIBULUM,  AND  PLEXUS  CHO- 
ROIDES. 

XV.  AA.  COMMUNICANS.     Constituting  part  of  the  circle  of 
Willis. 

V.  AA.   CEREBRALIS   ANTFRIOR.     1.  Irregular  branches  to 

the  first  and  second  pair  of  nerves  :  2.  lesser  irregular 
branches  to  the  anterior  lobe  ;  3.  anterior  communi- 
cans  (completing  the  circle  of  Willis  interio/ly)  4. 
arteria  corporis  callosi. 

VI.  AA.  CEREBRALIS  MEDIA.     Entering  the  fossa  Silvii ;  it 

is  minutely  distributed  to  the  substance  of  the  middle 
lobe. 

OF  THE  VEINS  OF  THE  HEAD. 

The  veins  of  the  face  and  neck  may  be  seen  without  their 
being  injected;  indeed,  this  should  never  be  done,  except 
when  we  wish  to  make  a  preparation  of  them.  For  this 
purpose,  a  pipe  should  be  placed  in  the  frontal  vein,  through 
which  a  quantity  of  warm  water  should  be  thrown,  so  as  to 
clear  the  superficial  veins  of  their  coagula.  To  distend  the 
deep  veins,  a  pipe  should  be  put  into  the  longitudinal  sinus, 
directed  towards  the  occiput,  (a  portion  of  the  scull  having 
been  previously  removed  :  or  they  may  be  filled  by  putting  a 
pipe  into  each  internal  jugular  vein.  *The  success  of  the  in- 


255 

jection  will  depend  very  much  on  the  veins  being  thoroughly 
cleared  of  the  blood  which  is  coagulated  in  them. 

After  they  are  injected,  the  dissection  will  be  very  easily 
made ;  for  the  veins  are  so  superficial,  that,  in  a  thin  body, 
they  will  be  seen  under  the  skin. 

The  vein  which  may  be  traced  from  the  inner  angle  of  the 
eye,  towards  the  lower  jaw,  is  the  Anterior  Facial  ^  or  the 
Angularis*  This  vein  receives  branches  from  various  parts 
of  the  face,  which  are  named  according  to  the  points  from 
which  they  come  ;  as,  venafrontalis  ;  vena  ophtlialmica  ;  ve- 
na dorsalis  nasi,  superior  et "inferior  ;  vena  alaris  nasi  ;  vence 
labiales,  magnce  et  minores  ;  vence  buccales,  fyc.  At  the  angle 
of  the  jaw,  the  Facial  vein  will  be  found  to  unite  with  the 
Temporal,  or,  as  it  is  sometimes  called,  the  Posterior  Facial. 
By  this  union,  the  External  Jugular  is  generally  formed. 

The  temporal  vein  is  formed  by  branches  which  come  from 
the  temple  (generally  four  in  number) ;  by  the  veins  which 
accompany  the  branches  of  the  arteria  maxillaris  interna  ; 
by  the  transversals  faciei  ;  the  posterior  aims  ;  and  some- 
times, by  branches  from  those  accompanying  the  arteria  Hie- 
niiigea  media. 

The  External  Jugular  will  be  found  to  be  very  irregular  ; 
sometimes  it  divides  into  two  branches,  the  one  being  called 
the  anterior,  the  other. posterior.  The  anterior  division  gen- 
erally receives  the  branches  under  the  chin,  and  from  the 
tongue,  and  often  joins  the  great  internal  jugular  vein :  while 
the  posterior  receives  some  from  the  occiput  and  the  back 
part  of  the  ear,  and  then  passes  down  to  thesubclavian, — in 
its  course,  receiving  veins  from  the  outer  part  of  the  neck, 
and  upper  part  of  the  shoulder. 

The  veins  of  the  thyroid  correspond  very  much  with  the 
course  of  the  .arteries ;  the  superior  ones  passing  into  the  jug- 
rJar,  and  the  inferior  into  the  subclavian,  or  the  transverse 
vein,  which  passes  across  the  great  arteries. 

The  Internal  Jugular  vein  is  formed  principally  by  the 
sinuses  of  the  dura  mater,  which  have  already  been  describ- 
e  1  at  p.  173  :  but  in  its  passage  down  the  neck,  it  generally 
receives  the  branches  corresponding  to  the  deep  arteries. 

It  will  be  difficult  to  trace  the  branches  of  the  Vertebral 
Veins.     The  basilar  sinus  generally  passes  into  them  ;  they 
receive,  also,  the  branches  from  the  upper  part  of  the  spinal 
marrow  :  but  they  are  principally  formed  by  a  net- work  of 
veins,  which  surrounds  the  processes  of  the  spine,  and  come 
from  the  deep  arteries  which  supply  the  small  muscles  of  the 
back.     The  trunk  of  the  vein  passes  in  the  same  canal 
the  artery,   viz.  in  the  transverse  processes,  and  termir. 
in.  the  subclavian  vein. 


256 

DISSECTION 

OF  THE 

OF  THE  HEAD  JtND  NECK. 


WE  may  begin  either  with  the  dissection  of  the  nerves  of 
the  face,  which  are  from  the  Vth  and  the  Vllth,  or  with  the 
plexus,  which  is  formed  immediately  under  the  skin  of  the 
neck,  by  the  superficial  branches  of  the  cervical  nerves  and 
spinal  accessory.* 

1  shall  suppose  that  we  are  to  dissect  those  of  the  neck  first. 
If  we  cut  through  the  skin,  about  opposite  to  the  middle  of 
the  sterno  cleido  raastoideus,  we  shall  find  some  branches, 
which,  if  patiently  followed,  will  lead  to  all  the  others.  The 
nerves  on  the  side  of  the  neck  are  so  numerous,  that  it  is  im- 
possible, in  a  work  of  this  kind,  to  particularize  them  all ; 
but  there  is  one  more  distinct  than  the  others,  which  passes 
from  the  third  cervical,  along-  the  sterno  cleido  mastoideus 
muscle,  to  join  the  branches  of  the  portio  dura.  This  branch 
is  sometimes  called,  nervus  communicans,  or  superficialu  Colli, 
When  the  skin  over  the  parotid  is  raised,  some  branches  of 
the  Portio  Dura,  or  respiratory  nerve,  of  the  face,  will  be  seen. 
These  may  be  traced  into  the  substance  of  the  parotid 
gland,  by  digging  with  the  scissors  ;  this  is  to  be  done,  by 
putting  in  the  blades,  closed,  and  then  opening  them,  by 
which  the  portions  of  the  gland  will  be  torn,  rather  than  cut. 

In  following  the  branches  ofthe  portio  dura  upon  the  face, 
we  should  not  remove  more  ofthe  skin  than  the  cutis  vera* 
for  many  ofthe  principal  branches  lie  immediately  under  it ; 

*  In  the  following  description  ofthe  manner  of  dissecting 
the  nerves,  I  shall  introduce,  in  the  form  of  notes,  some  of 
those  observations  which  Mr.  Bell  has  been  for  many  years 
in  the  habit  of  making  while  delivering  his.  lectures  on  the 
nerves  ;  several  of  these  will  be  found  in  the  edition  of  the 
Plates  of  the  Nerves,  published  in  1816.  I  shall  only  hint  at 
certain  experiments  which  are  detailed  by  Mr.  Bell,  in,  a  pa- 
per in  the  transactions  of  the  Royal  Society  for  the  present 
year.  The  new  names  which  have  been  given  to  some  ofthe 
nerves,  will  be  underptood  by  referring  to  the  explanation  uf 
tf>«  plate*. 


257 

these  will  be  found,  in  their  course  from  the  interior  of  the 
parotid  to  the  different  parts  of  the  face,  to  be  united  togeth- 
er by  cellular  membrane,  so  as  to  have  some  resemblance  to 
the  webbed  foot  of  an  aquatic  bird,  whence  the  name  of  pes 
anserinus  has  been  given  to  the  plexus  which  is  formed  by 
them. 

The  three  branches,  viz.  the  Supra  Orbital,  Superior  Jftaril- 
lary,  and  Inferior  Maxillary,  of  the  Vth,*  will  be  easily  dis- 
covered by  recollecting  the  three  foramina  through  which 
they  pass  to  the  face,  viz.  the  Superior  Orbital,  Infra  Orbi- 
tal, and  Mental.  After  the  trunks  are  exposed,  there  will  be 
no  difficulty  in  tracing  their  branches  to  their  terminations, 
and  also  to  show  the  intimate  connection  which  each  of  them 
has  with  the  branches  of  the  portio  dura.  The  dissection 
will  be  most  easily  made,  by  tearing  the  cellular  membrane 
from  between  the  nerves,  by  using  the  srissors  and  a  small 
hook,  in  the  manner  already  described.! 

After  having  seen  all  the  superficial  nerves,  we  may  pro- 
ceed to  the  dissection  of  those  which  lie  deeper. 

The  platisma  may  now  be  removed,  and  the  external  sur- 
face of  the  sterno  cleido  mastoideus  be  dissected  clean  ;  so 
may  the  digastricus  superior,  and  the  mylo  hyoideus :  but  we 
must  not  take  off.all  the  cellular  membrane  from  the  sterno 
hyoideus  and  thyroideus  muscles,  because  in  doing  so,  we 
should  cut  across  some  of  the  branches  of  the  descendant 
noni. 

The  origins  of  the  sterno  cleido  mastoideus  may  now  be 
raised,  and  the  muscle  be  carried  towards  its  insertion.  In 
doing  this,  we  shall  see,  at  about  two  inches  from  the  mas- 
toid  process,  the  Superior  Respiratory  Nerve,  or  Spinal  Jtr.- 
cessory,\  entering  into  its  substance,  and  perforating  it,  in  an 
oblique  direction.  After  tracing  the  branches  of  this  nerve, 
we  ..hould  cut  through  the  digastricus  superior,  so  as  to  ex- 
pose the  stylo  hyoideus  ;  immediately  below  the  level  of 
which,  we  shall  discover  the  IXth,  or  Lingual  Nerce^  run- 
ning towards  the  os  hyoideus  :  if  we  pull  upon  it,  we  ^hall 
see  a  small  branch  running  down  the  neck,  towards  the  mus- 

*  See  the  notes  upon  the  deep  dissection  of  these  nerves. 

f  When  we  have  finished  the  dissection  for  the  day,  we 
should  either  cover  the  parts  with  a  wet  cloth,  or  put  them 
into  water ;  by  this,  the  nerves  will  be  blanched,  and  after- 
wards more  distinctly  seen.  If  bougies,  or  black  pins,  be 
put  under  the  nerves  which  have  been  dissected,  the  display 
will  be  still  more  distinct. 

t  See  note  upon  this,  in  the  deep  dissection. 


258 

cles  on  the  larynx  ; — this  twig  is  the  descendens  rxmi,  which, 
if  followed,  will  be  found  to  pass  along  the  sheath  surround- 
ing- the  carotid  artery  and  jugular  vein,  and  to  form  connec- 
tions with  some  of  the  cervical  nerves.  It  is  lost  upon  the 
sterno  hyoideus  and  thyroideus  muscle.* 

The  trunk  of  the  IXth  may  be  traced  a  little  forward,  but 
not  far,  as  we  shall  have  a  better  opportunity  of  seeing  it 
presently. 

The  sheath  :of  the  vessels  may  now  be  opened.  Immedi- 
ately between  the  artery  and  vein,  the  groat  nerve,  the  Par 
Vagum,  will  be  seen  :  and  if  we  lift  up  the  sheath  altogeth- 
er, we  shall  find  the  sympathetic,  lying  closB  upon  the  mus- 
cles of  the. spine.  These  nerves  may  be  exposed  for  a  short 
distance  ;  but,  those  below  the  angle  of  the  jaw,  must  be  dis- 
sected, before  we  can  show  their  connections. 

The  first  nerves  which  we  should  dissect  under  the  jaw, 
are  the  three  which  pass  to  the  tongue.  We  have  already 
seen  the  IXth,  or  Motor  Linguce. 

If  we  now  hold  aside  the  submaxillary  gland,  and  cut  care- 
fully  through  the  mylo  hyoideus,  we  shall  seethe  Gustatory  ; 
and  by  lifting  up  the  lobe  of  the  parotid  gland,  and  dissecting 
along  the  line  of  the  stylo  pharyngeus  and  glosso  pharyngeus 
muscles,  we  shall  find  the  Glosso  Pharyngeal^  which*  is  the 
third  nerve  of  the  tongue,  f 

*  In  the  connections  of  the  seventh,  the  ninth,  the  nervus 
&uperficialis,  cervicales,  the  roots  of  the  phrenic,  and  that 
which  is  called  the  external  respiratory, — we  see  the  media 
of  many  combinations :  the  expression  and  consent  of  parts 
in  sneezing,  coughing,  vomiting  ;  the  expressive  spasmodic 
actions  during  violent  passion  ;  the  spasms  in  hydrophobia 
and  tetanus.  In  the  connections  of  the  phrenic  nerve  with 
the  cervical  nerves,  we  may  observe  the  source  of  that  re- 
markable sympathy  which  makes  the  affection,  or  wound  of 
the  diaphragm,  be  attended  with  pain  in  the  shoulders,  or 
convulsive  rising  and  shrugging  of  the  shoulders. 

f  The  gustatory  nerve  connects  the  salivary  glands  and 
muscles  of  mavstication. — The  ninth  is  the  nerve  of  speech, 
a  id  connects  the  tongue  with  the  muscles  of  the  larynx  and 
trachea. — The  glosso  pharyngeai  nerve  associates  the  tongue 
and  pharynx  in  the  action  of  deglutition.  We  may  now 
comprehend  how  the  tongue,  being  put  into  action  through 
the  intervention  of  distinct  nerves,,  may  be  deprived  of  one 
faculty,  and  retain  the  others. — Thus,  a  Sections  of  the  brafh, 
and  sometimes  the  disorders  of  the  bowels,  deprive  the  pa- 
tient, at  one  time  of  taste,  at  anoiher  of  speech3  or  at  anot&ei 
$f  swallowing. 


259 

But  to  facilitate  this  part  of  the  dissection,  and  of  the  other 
deep- nerves,  the  jaw  should  be  cut  through  at  the  symphy- 
sis  and  at  the  angle  ;  and  after  the  membrane  ofthe  mouth 
has  been  separated  from  the  bone,  the  intermediate  portion 
may  be  removed.  A  piece  of  twine  is  then  to  be  put  thrcugfc 
the  tip  of  the  tongue,  by  which  it  nray  be  pulled  out 

By  holding  aside  the  remaining  parts  of  the  jaw,  fc  great 
nerve  will  be  discovered,  emerging  from  between  the  two 
pterygoid  muscles  ;  this  is  third  of  the  Vth,  being  the 
trunk  of  the  Gustatory,  and  of  the  Inferior  Maxillary. 

After  the  inferior  maxillary  has  been  traced  into  the  hole 
in  the  jaw  bone,  it  should  be  cut  through,  and  a  piece  of  co- 
loured thread  attached  to  it,  by  which  we  may  again  recog- 
nize it.  The  remaining  portion  of  the  jaw  may  now  be  re- 
moved ;  but  we  must  be  particularly  careful  in  extricating 
the  condyle,  or  we  shall  be  in  danger  of  cutting  a  little  nerve, 
\vhich  funs  backwards  from  the  lower  part  of  the  gustatory* 
just  at  the  point  where  it  separates  \  rom  the  inferior  maxil- 
lary. This  small  twig  will  afterwards  be  found  to  paes 
through  a  little  hole  by  the  side  of  the  glenohl  cavity  >  and 
then  to  cross  the  merrlbrana  tympani  (whence  its  name  of 
cordatympani  ;)  it  joins  the  portio  dura,  but  perhaps  it  will 
be  more  proper  to  describe  it  as  a  branch  coming  from  the 
portio  dura,  to  unite  with  the  Vth.* 

The  jaw  being. now  entirely  removed,  we  shall  have  a 
beautiful  exhibition  of  the  nerves  of  the  tongue ;  for  by 
merely  pulling  it  out,  we  may  trace  the  Gustatory  to  the 
tip, — the  lingual  to  the  muscles* — and  the  glosso  pharyngeal 
lo  the  tongue  and  pharynx. 

We  may  now  dissect  away  the  parotid,  and  also  the  sty- 
loid  muscles,  and  «,s  many  of  the  branches  of  the  carotid  as 
we  can^  without  injuring  the  trunk  of  the  portio  dura  :  this 
will  expose  what  appears  at  first  a  very  intricate  plexus  of 
nerves,  but  if  we  put  probes  under  all  those  which  have  been 
already  described,  we  shall  find  the  intricacy  to  be  very 
much  unravelled.  If  we  look  towards  the  tongue,  we  shall 
aee  the  Lingual  Gktstatory,  and  Glosso  Pharyngeal ;  and  to- 
wards the  back  of  the  ear,  the  Portio  Dura  and  Spinal  Ac- 
cessory ;  and  downwards,  the  Par  Vagicm  and  Sympathetic. 
These  nerves  now7  enumerated,  are  the  only  ones  to  be  found 
in  the  neck,  except  those  which  come  direct  from  the  spinal 
marrow,  viz.  the  Cervical  Nerves. 

We  should  now  trace  the  Par  Vagum.  It  will  be  found 
to  be  swollen  into  a  sort  of  ganglion,  where  it  emerges  from 
the  scull,  and  to  be  intimately  connected  with  all  the  other 

*  See  Note  upon  this,  in  the  deep  dissection. 


200 

nerves  under  the  angle  of  the  jaw.  The  first  distinct  branch- 
es which  will  he  found  rising  from  it,  are  two  small  nerves, 
which  go  to  the  pharynx :  at  about  an  inch  farther  down,  a 
large  branch  will  be  seen  going  off  from  it,  obliquely  down- 
wards, and  across  the  neck,  to  pass  into  the  larynx,  between 
the  thyroid  and  cricoid  cartilages, — this  branch  is  called  the 
Superior  Larun^eal.  The  trunk  of  the  nerve  may  then  be 
traced  down  by  the  outside  of  the  carotid,  giving  off  no 
branches  which  have  names,  until  it  passes  into  the  thorax. 
But  as  yet,  we  should  not  follow  the  nerve  farther  than  the 
first  rib;  however,  by  looking1  between  the  oesophagus  and 
larynx,  we  shall  discover  the  first  branch  which  it  gives  oft' 
while  in  the  thorax;  for  it  is  a  Recurrent  nerve,  which 
comes  back  into  the  neck,  to  pass  into  the  larynx,  between 
the  lower  part  of  the  thyroid  and  cricoid  cartilages  :  it? 
branches  unite  with  the  superior  laryngeal ;  it  is  often  cal- 
led the  inferior  laryngeal  nerve.* 

The  Symprtfhetie  is  now  to  be  traced.  We  shall  first  ob- 
serve the  enlargement  of  it  under  the  parotid  ;  this  is  called 
its  superior  ganglion,  from  which  it  sends  off  branches  to 
every  one  of  the  other  nerves.  As  we  trace  it  down  the 
neck,  we  shall  observe  that  it  sends  twigs  to  the  cervical 
nerves,  and  nl-o  some  very  soft  delicate  filaments  to  the  arte- 
ry, which,  from  their  appearance,  have  been  called  ncrm 
molles.  About,  the  middle  of  the  neck,  we  generally,  but 
not  always,  (and  oflener  on  the  left  than  the  right  side)  find 
another  ganglion, — From  this,  some  very  delicate  nerves 
will  be  seen  to  pass,  in  a  direction  more  superficial  than  the 
others;  these  may  afterwards  be  traced  over  the  aorta,  to 

*  In  the  distribution  of  the  branches  of  the  eighth  nerve 
to  the  larynx  and  glottis,  we  remark  that  connection  which 
so  intimately  unites  the  larynx  and  lungs.  We  observe  how 
the  slightest  irritation  on  the  former  calls  into  activity  the 
whole  respiratory  system.  By  its  connections  with  phrenic 
and  other  respiratory  nerves,  it  governs  the  actions  of  the 
muscles  in  respiration  ;  and  being  also  the  nerve  of  the 
stomach,  by  the  same  connections,  it  governs  the  muscles  in 
vomiting,  combining  them  in  a  different  manner,  to  produce 
that  action. 

In  vomiting  and  in  respiration,  the  same  muscles  are  in 
action,  but  they  are  differently  combined  ;  and  muscles 
which  in  respiration  are  opponents,  become  coadjutors  in 
vomiting.  The  variety  of  combinations  of  which  these  mus- 
cles are  capable,  explains  the  meaning  of  that  intricacy  and 
minuteness  of  subdivision,  which  characterize  the  nerves  of 
the  neck  and  chest. 


261 

assist  in  forming  the  mperfaml  cardiac  pJevus.  The 
branch  of  the  sympathetic  continues  to  pass  down,  until  it 
comes  to  opposite  the  first  rih,  and  there  it  forms  the  tower 
cervical  ganglion,  from  which  branches  go  to  encircle  the 
subclavian  and  lower  thyroid  arteries.  But  here,  we  must 
for  the  present  give  up  the  pursuit  of  this  nerve.  We 
should  now  turn  to  the  dissection  of  the  lateral  part  of  the 
neck. 

If  we  carefully  dissect  the  anterior  scalenus  muscle,  we 
shall  see  the  Phrenic,  or  great  internal  muscular  nerve  of 
respiration,  lying  upon  it ;  upon  tracing  this  nerve  back,  it 
will  be  seen  to  arise  from  several  of  the  cervical  nerves.* 
By  then  dissecting  on  the  lower  edge  of  the  scalenns,  and 
by  throwing  out  the  arm,  we  shall  see  a  certain  number  of 
these  cervical  nerves,  pissing  to  form  the  axillary  plexus, 
viz.  the  four  inferior  cervical,  and  the  first  dorsal.  But  be- 
fore we  trace  these  nerves  back  towards  the  spinal  marrow, 
we  should  cut  to  the  depth  of  a  quarter  of  an  inch  through 
the  fibres  of  the  scalenus  anticus;  and  then,  about  opposite 
to  where  the  phrenie  lies,  we  shall  see  a  nerve,  which  rises 
from  nearly  the  same  roots  as  the  phrenic,  and  which  runs 
under  the  axillary  plexus,  as  a  distinct  nerve,  to  the  external 
muscles  of  respiration  :  this  branch,  Mr.  Bell  has  called  the 
External  Nerve  of  the  muscles  of  Respiration. 

As  we  shall  now  have  exhibited  all  the  principal  branches 
of  the  neck,  we  may,  after  making  them  more  distinct,  pase 
either  to  the  dissection  of  the  deep  nerves  of  the  scull,  or  to 
those  of  the  thorax  and  abdomen.  If  the  body  is  not  very 
fresh,  we  should  first  dissect  those  of  the  thorax. — The  deep 
nerves  of  the  scull  will  be  more  distinctly  seen,  if  the  parts 
have  been  previously  soaked  in  water. 

*This  nerve  is  generally  described  as  rising  from  the  third 
and  fourth  cervical :  but  by  dissecting  it  carefully,  we  shall 
find  that  it  has  origins  from  the  portio  dura,  and  from  the 
ninth,  and  also  the  spinal  accessory. 

It  is  a  curious  fact,  that  this  is  the  only  nerve  which  was. 
previous  to  the  discoveries  of  Mr.  Bell,  considered  as  a  res- 
piratory nerve  to  the  muscles.  He  has  called  it  the  Inter- 
nal Respiratory  Nerve,- 


262 
DISSECTION 

OF 

THE  JVERVES 

IN 

THE  THORAX  AND  ABDOMEN. 


THE  viscera  of  the  thorax  and  of  the  abdomen,  should,  m 
the  first  dissection  of  the  nerves,  be  sacrificed  to  it.  But 
after  the  nerves  have  been  once  fairly  seen,  there  will  he  no 
difficulty  in  exposing  them,  in  union  with  the  arteries,  in 
future  dissections. 

The  thorax  is  to  be  opened,  by  removing  the  sternum, 
with  the  cartilages  of  the  ribs :  but  in  doing  this,  we  should 
cut  very  close  upon  the  inside  of  the  upper  part  of  the  ster- 
num, as  some  of  the  nerves  lie  very  nea.r  the  inner  surfa'ce 
of  the  bone. 

If  there  be  no  disease  in  the  viscera  of  the  thorax,  the 
Phrenic  Nerve  of  the  left  side  will  be  seen  passing  over  the 
pericardium,  immediately  opposite  to  the  apex  of  the  heart ; 
the  one  on  the  right  side,  id  situateu  rather  lower  down  on 
the  pericardium. — There  will  be  no  difficulty  in  showing  the 
distribution  of  these  nerves  upon  the  diaphragm. 

The  dissection  of  the  next  set  of  nerves  requires  great 
care.  If  we  look  to  the  middle  cervical  ganglion,  or  to  the 
point  of  the  sympathetic,  where  this  ganglion  is  generally 
.  found,  some  very  delicate  branches  will  he  seen  going  oft'; 
and  which,  if  carefully  traced  will  be  found  passing  to  form 
the  Superficial  Cardiac  Plexus. 

The  par  vagum  should  be  traced  into  the  thorax,  before 
the  deeper  branches  of  the  SympfitheHc. 

On  the  left  side,  the  par  vagum  will  be  seen  passing  over 
the  aorta,  towards  the  lower  part  of  the  heart  and  the  lungs* 
While  it  lies  on  the  aorta,  it  gives  off  that  branch  which  has 
already  been  seen  running  to  the  lower  part  of  the  larynx, 
viz.  the  Inferior  Laryn^eal,  or  Recurrent  ;— on  the  right  side, 
tjje  recurrent  passes  round  the  subsclavian  artery. 


263 

The  par  vagum*  will  now  be  found  to  form  intricate 
plexuses  of  branches  with  the  sympathetic,  for  the  supply  of 
the  back  part  of  the  heart,  and  of  the  anterior  and  poste- 
rior part  of  the  lungs.  These  branches  form  the  Deep  Car- 
diac Plexus,  and  the  anterior  and  posterior  Pulnwnic  1 
uses  ;  but  to  see  them  distinctly,  we  shall  be  obliged  to  cut 
off  the  ribs  at  the  angles,  on  one,  or  both  sides.  If  we  then 
pull  up  the  lung,  we  shall  be  able  to  see  not  only  these  plex- 
uses, but  also  those  branches  of  the  par  vagum,  which  en- 
circle, or  run  in  a  net-work,  on  the  oesophagus,  and  which 
form  the  (J£soptiageal  Plexus.^  After  these  are  exposed,  if 

*  The  par  vagum  connects  the  larynx,  pharynx,  lungs, 
heart,  and  stomach;  and  the  sympathies  it  produces  in  health 
and  disease,  are  very  many.  Disorder  of  the  stomach  de- 
ranges the  secretion  of  the  larynx:  a  vqinit,  or  nauseating 
medicine  will  loosen  the  viscid  secretion  of  the  larynx  and 
pharynx ;  disorders  of  the  stomach,  acting  through  the  pul- 
monic  plexus,  will  occasion  cough  ;(  and  medicines  acting  on 
the  stomach  will  alleviate  asthma.  Through  the  plexus  of 
this  nerve,  the  heart  and  lungs  are  united,  ever  correspond- 
ing in  action.  When  life  seems  extinguished  by  suffocation, 
(in  experiments  on  animals)  pricking  the  heart  will  be  fol- 
lowed by  respiration  ;  and  in  the  apparently  drowned,  the 
play  of  the  lungs,  in  artificial  breathing,  brings  after  it  the 
action  of  the  heart.  It  is  well  known  how  disease  of  ihn 
lungs  affects  the  heart ;  but  it  is  not  so  generally  observed 
how  much  disease  of  the  heart  resembles  pulmonary  dis- 
ease. 

Looking  to  the  distribution  of  the  par  vagum  on  the  sto- 
mach, and  the  plexus  of  the  nerve,  in  its  course  upon  tho 
oesophagus,  it  will  not  appear  surprising,  that  disorder  of  the 
uterine  system,  atfecting  the  stomach,  and  also  primary  dis- 
orders of  the  stomach  itself,  should  produce  the  gtobv*  hys- 
iericM^  or  paralysis,  or  spasms  of  the  pharynx  and  oesopha- 
gi**. Although  the  heart  a ud  stomach  be  separated  by.  the 
diaphragm,  yet  through  this  nervous  cord  they  are  united  ; 
and  this  explains  why  disorder  of  the  stomach  should  pro- 
duce such  changes  on  the  heart's  action.  The  pause,  or  in- 
termission of  tlie  pulse,  which,  in  many  diseases,  is  a  fatal 
symptom,  is  often  produced  in  a  manner  less  alarming, — 
merely  by  irritation  of  the  stomach.  Seeing  these  many 
connections  of  the  stomach  with  the  vital  parts,  through 
this  nerve,  our  surprise  ceases  at  a  blow. on  the  Stomach 
proving  instantly  fatal. 

fin  the  dissection  of  the  camel,  we  discovered  a  very 


204 

we  merely  tear,  up  the  pleura,  we  shall  gee  the  continuation 
of  the  sympathetic  upon  the  inside  of  the  ribs,  forming,  at 
each  intercostal  space,  a  union  with  the  dorsal  or  intercostal 
nerves,  through  the  medium  of  a  small  ganglion.  If  we 
then  trace  the  sympathetic  backwards,  we  shall  find  that  it 
encircles  the  subclavian  artery  with  a  plexus  of  branches, 
from  the  anterior  part  of  which,  those  going  to  the  viscera 
of  the  thorax  pass  oft', — while  the  deeper  branch  forms  a  dis- 
tinct ganglion,  and  then  passes  down  along  the  ribs,  as  that 
nerve  which  according  to  the  old  nomenclature,  was  called 
h  e  Intercostal.* 

By  now  tracing  the  oesophagus  through  the  diaphragm, 
we  shall  see  the  united  branches  of  the  par  vagum  passing 
upon  the  cardiac  part  of  the  stomach,  to  form  the  plexus 
which  has  been  celled  the  Corda  Ventriculi.  We  should 
then  look  to  the  side  of  the  chest,  and  we  shall  see  three  or 
four  branches  passing  off  from  the  sympathetic  towards  the 
bodies  of  the  vertebrae:  th€;re  they  unite  and  form^a  division, 
which  is  called  the  Anterior  Splanchnic,  which  will  be  found 
to  perforate  the' diaphragm.  By  looking  on  the  abdominal 
side  of  the  diaphragm,  we  shall,  by  pulling  upon  the  nerve 
within  the  chest,  discover  that  a  large  g:anglion  is  formed 
immediately  by  the  root  of  the  cceliac  artery  :  this,  being  of 
a  crescentic  shape,  is  called  the  Semilvnar  Ganglion  ;  but  it 
has  more  the  appearance  of  a  lymphatic  gland  than  of  any 
part  belonging  to  the  nervous  system. 

From  the  gangloiri  of  each  side,  branches  pass  off,  to  unite 
together,  and  with  those  of  the  par  vagum.  so  as  to  form  a 
great  plexus,  which  has  been  called  the  Cceliac  Plexus,  of, 
more  commonly,  the  Solar  Plexw ;  from  which,  we  may 
trace  branches  to  each  division  of  the  viscera.  If  we  lift  up 
the  liver,  we  shall  see  a  set  of  nerves  passing  along  the  he- 
patic artery,  and  which  form  the  Hepatic  Plezux.  If  we  dis- 
sect in  the  course  of  the  splenic  artery,  we  shall  see  the 
Splenic  Plexus ; — and,  in  the  same  manner,  the  Renal  Plexu* 

beautiful  plexus  of  nerves  upon  the  oesophagus;  these  were 
in  connection  with  a  set  of  branches  on  the  upper  part  of  the 
pharynx.  As  these  were  also  seen  in  the  calf,  and  not  in  the 
asSj — it  is  reasonable  to  suppose  that  they  are  peculiar  to 
the  ruminating  animals,  to  combine  the  actions  of  the 
pharynx  and  stomach. 

*  In  dissecting  the  deep  nerves  of  the  thorax,  we  should 
place  the  body  so,  that  the  viscera  of  the  abdcmen  shall  drag- 
down  the  diaphragm.  It  will  be  still  better  to  open  the  ab- 
domen, and  to  remove  all  the  small  intestines,  before  the  dis- 
section of  the  nerves  of  Uae  thorax  is  completed. 


to  the  kidney ;  and  the  Superior  and  Inferior  Mesenteric  P/tu  * 
mes  to  the  small  intestines ;  and  also  the  Spenmtic  Plexus  to 
the  testicle,  and  the  Hypogastric  Plexus  to  the  bladder.  In 
dissecting  these  plexuses,  we  should  put  probes  under  those 
which  have  been  exposed,  that  they  may  not  be  lost  while 
we  are  in  search  of  the  others. 

If,  after  these  nerves  of  the  viscera  have  been  shown,  the 
peritoneum  be  lifted  up  from  the  spine,  the  sympathetic  will 
be  seen  passing  from  the  thorax,  along  the  lumbar  vertebrae,* 
and  forming  connexions  with  each  of  the  lumbar  nerves,  by 
a,  series  of  small  ganglions  ;  and  if  we  follow  it  into  the  pel- 
vis, \ve  shall  find  that  it  is  connected  with  the  nerves  which 
pass  to  the  leg.  The  sympathetic  of  the  two  sides  will  at 
last  be  found  united  on  the  extremity  of  the  sacrum,  forming 
a  small  ganglion,  which  is  called  the  Coccygeal  Ganglion ,  or 


This  description  is  very  superficial ;  but  I  hope  it  will  be 
sufficient  to  enable  the  dissector  to  make  out  what,  is  com- 


iion  Sin  c  Pari. 
is  description  is 
ient  to  enable  t] 
monly  considered  the  anatomy  of  these  nerves.f     But  1 

*  A  small  division  of  the  nerve  which  sometimes  comes  oft' 
from  the  sympathetic,  about  opposite  to  the  llth  or  12th  rib, 
and  passes  to  the  ganglion,  or  to  the  renal  plexus,  is  called 
the  Lesser  Splanchnic,  or  Accessory. 

f  During  the  inquiries  which  have  of  late  or  years,  been 
carried  on  in  Windmill-Street,  into  the  distinctions  in  the 
structure  and  uses  of  the  several  nerves,  none  of  the  experi- 
ments have  been  repeated  which  were  instituted  by  several 
gentlemen,  to  discover  how  far  the  functions  of  the  stomach 
are  influenced  by  cutting  the  per  vagum. 

It  has  not  been  from  indolence,  that  they  have  been  neg- 
lected, but  from  a  conviction,  that  such  experiments  could 
not  be  attended  with  any  satisfactory  results.  Perhaps  it 
will  be  allowed,  that  the  conflicting  reports,  which  have  late- 
ly been  drawn  up  by  the  gentlemen  who  have  been  engaged 
in  these  experiments,  warrant  the  opinion  which  had  been 
previously  formed  by  Mr.  Bell,  that  the  par  vagum  was  a 
bond  of  connection  between  the  several  organs, — and  not  a. 
source  of  nervous  energy  to  the  stomach.  This  opinion  was 
founded  on  the  minute  examination  of  the  anatomy  of  the 
several  nerves,  and  particularly  on  the  fact  established  by 
comparative  anatomy, — that  stomachs  of  the  most  powerful 
digestion,  in  the  lower  animals,  were  independent  of  the 
par  vagum :  which  is  proved  by  the  very  conclusive  evi- 
dence, that  in  many  of  those  animals,  there  is  no  par  vagum. 

The  use  of  the  nerve,  and  the  phenomena  which  take  place 


266 

Would  advise  the  student  who  is  anxious  to  know  the  subject 
minutely,  to  repeat  the  dissection  frequently  in  the  lower 

upon  cutting  it,  may,  perhaps,  be  understood  by  the  investi- 
gation of  comparative  anatomy ;  for  by  it,  we  shall  find, 
that  the  existence  of  this  nerve  depends  upon  the  manner  in 
which  an  animal  respires,  and  upon  the  connection  which 
there  is  between  the/  stomach  and  the  organs  of  respiration. 
And  as,  in  complicated  animals,  the  par  vagum  passes  to  the 
throat,  the  larynx,  the  heart,  the  lungs,  and  the  stomach, — 
we  may  be  permitted  to  draw  the  conclusion,  that  it  is  for 
connecting  and  combining,  into  one  great  system,  these  se* 
veral  organs, — each  of  which,  has  the  power  of  performing. 
to  a  certain  extent,  its  own  peculiar  function :  but  if  it  be 
cut  through,  then  the  connexion  between  all  the  organs, 
and  also  with  the  external  muscular  apparatus,  upon  which 
imperfection  of  the  economy  of  each  depends,  must  be  de- 
stroyed. 

From  what  I  have  seen  in  experiments  on  the  portio  dura< 
and  other  nerves  of  the  neck,  I  can  readily  believe  in  the  ef- 
fects of  the  galvanic  influence  on  the  par  vagum,  when  divi- 
ded :  indeed  it  would  be  unwarrantable  incredulity  to  doubt 
it,  after  the  assertions  that  have  been  made.  But  still  the 
question  is  open,  whether  the  phenomena  are  to  be  explain- 
ed in  the  manner  proposed  by  Dr.  Philip. 

If  we  pinch  the  divided  portio  dura,  the  muscles  to  which 
it  goes  will  be  slightly  convulsed, — if  we  touch  it  with  acid, 
they  will  be  more  so, — but  when  we  galvanize  the  nerve,  the 
muscles  will  be  thrown  into  full  action  :  thus,  it  would  ap- 
pear, that  the  energies  of  a  nerve  are  excited  in  proportion 
to  the  degree  of  stimulus.  From  these  experiments,  it  would 
be  as  just  to  call  a  pair  of  pincers,  or  an  essential  oil,  or  an 
acid,  the  nervous  agent^  as  the  galvanic  pile. 

Before  instituting  the  experiments  with  galvanism,  the 
fact  was  assumed,  that  by  dividing  the  par  vagum  in  the 
neck,  all  connexion  between  the  brain  and  the  stomach  must 
be  destroyed.  This  I  cannot  agree  to  ;  for  by  a  careful 
dissection  of  the  nerves,  I  find  that,  at  every  point  of  the  ab- 
domen and  thorax,  the  par  vagum  and  sympathetic  have  in- 
timate connexions  with  the  spinal  marrow, — and  conse- 
quently, through  it,  with  the  brain. 

I  trust,  that  in  examining  a  point  of  physiology  which 
inust  depend  so  much  on  the  facts  of  anatomy,  it  will  not  be 
considered  invidious  in  me  to  question  how  far  the  anatomy 
of  the  nerves  has  been  attended  to,  in  the  experiments,  and 
in  the  discussions  which  have  taken  place  upon  it. 

I  think  it  will  be  admitted,  that  the  greater  number  of  the 


267 

animals  *  and  then  I  hope,  with  the  assistance  of  the  hints 
which  are  given  in  the  notes,  that  he  will  be  able  to  make 

late  experiments  appear  to  have  been  founded  on  the  views 
of  the  anatomy  of  the  ganglionic  system  of  nerves,  which 
were.given  by  Bichat.  Although  I  will,  in  common  with 
every  one,  acknowledge  Bichat  to  have  been  a  man  of  the 
most  brilliant  talents,  yet  I  will  venture  to  assert,  that  his 
description  of  the  anatomy  of  the  nerves,  as  it  now  stands, 
is  incorrect, — and  consequently,  all  his  ideas  on  the  gangli- 
onic  system  are  untenable.  If  this  be  granted, — it  follows, 
as  a  matter  of  course,  that  all  experiments  which  have  been 
instituted  under  the  idea  that  Bichat's  anatomical  observa- 
tions were  correct,  must  be  liable  to  objections.  However, 
in  justice  to  the  memory  of  Bichat,  I  must  mention  the  cir- 
cumstance told  by  his  biographer  : — that  he  had  commenced 
a  review  of  the  anatomy  of  the  nerves  ;  and  that  he  had  been 
actually  engaged  in  examining  the  cervical  ganglions,  on  the 
very  night  in  which  he  met  with  the  accident  which  led  to 
his  death.  It  would  appear  from  this,  that  he  had  some  sus- 
picions of  the  accuracy  of  his  former  labours  ;  with  which, 
'however,  those  who  have  followed  him,  have  been  content. 

In  proof  that  the  anatomy  has  not  been  sufficiently  attend- 
ed to,  in  conducting  these  experiments,  I  may  remark,  that 
from  the  intimate  manner  in  which  the  sympathetic  and  par 
vagum  of  many  animals  are  united,  where  they  lie  by  the 
side  of  the  larynx, — the  sympathetic  must  frequently  be  di- 
vided with  the  par  vagum,  when  the  experimenter  lias  sup- 
posed that  he  has  cut  only  the  latter  nerve.  That  this  has 
happened  in  the  experiments  on  the  horse,  I  have  not  the 
slightest  doubt:  for  I  have  found  it  very  difficult  to  separate 
these  two  nerves  from  each  other,  even  in  the  dead  animal. 
If  this  has  taken  place,  (and  which  I  have  every  reason  to 
believe,)  these  experiments  have  shown,  without  the  opera- 
tor's appearing  to  have  been  aware  of  it,  the  very  curious 
fact,  that  whether  the  par  vagum  be  cut  singly,  or  with  the 
sympathetic, — the  same  consequences  follow. 

The  most  extraordinary  circumstance,  regarding  these  en- 
quiries, remains  to  be  noticed.  The  same  gentlemen,  after 
having  made  a  great  many  experiments,  have,  during  their 
last  trials,  come  to  a  very"  unexpected  conclusion,  and  one 
which  they  did  not  contemplate  at  first,  viz.  that  the  powers 
of  the  stomach,  when  cut  off  by  the  division  of  the  par  va- 
gum, may  be  restored  by  the  approximation  of  the  divided 
ends,— and  that  if  a  portion  of  the  nerve  be  removed,  the 
power  of  digestion  will  be  renewed  by  forming  a  chain  of 


268 

•his,  which  has  hitherto  been  considered  a  fagging*  task, — i* 
pleasing  and  interesting  subject  of  inquiry. 

connexion  between  the  brain  and  the  stomach,  by  means  of 
galvanism* 

The  experiments  from  which  these  opinions  are  deduced: 
and  which  are,  as  yet,  very  few,  are  founded  on  the  assump- 
tions (which  has  already  been  denied)  that  the  power  of  di- 
gestion is  conveyed  from  the  brain  to  the  stomach,  through 
the  par  vagurn.  In  the  next  place,  it  is  assumed,  that  by 
cutting  out  a  portion  of  the  par  vagum,  the  connexion  be- 
tween the  brain  and  the  stomach  is  cut  off.  This  I  must  ob- 
ject to,  when  I  see  the  intimate  connection  which  there  is, 
at  every  point  of  the  thorax  and  abdomen,  between  the  par 
vagum  and  the  spinal  marrow,  and  of  course  with  the  brain. 

We  have  in  our  experiments,  found,  when  the  power  of  a 
muscle  depends  on  a  certain  nerve,  that  by  simply  cutting 
the  nerve,  the  same  effects  are  produced,  as  when  a  portion 
of  it  is  cut  out.  In  proof  of  this,  I  offer  the  experiment  of 
dividing  the  portio  dura,  in  the  horse  or  ass.  The  zig-zag 
structure  of  the  nerve,  appears  to  me  to  render  it  almost  im- 
possible, when  it  is  cut,  that  its  ends  shall  remain  in  contact ; 
at  all  events,  the  degree  of  retraction,  that  we  always  see  in 
the  portions  of  a  divided  nerve,  entitles  us  to  call  upon  the 
supporters  of  this  new  doctrine,  to  prove,  that  the  ends  of 
the  nerves  continued  in  contact  in  those  rabbits  in  which  the 
nerves  were  cut,  and  the  digestion  went  on. 

It  may  also  be  required  of  the  experimenters,  to  show, 
that  the  functions  of  the  stomach  will  be  restored  by  bring- 
ing the  ends  of  a  nerve  again  into  contact,  from  which  a  por-> 
tlon  has  been  removed, 

If  the  idea  be  correct,  that  there  is  a  great  and  immediate 
difference  between  the  consequences  of  simply  dividing  a 
nerve,  and  the  removing  a  portion  of  it, — will  it  not  follow, 
that  little  or  no  effect  would  be  produced  by  the  application 
of  a  ligature  on  the  par  vagum,  since  by  this,  ther/if 
connexion  will  not  be  broken  ? 


269 

DISSECTION 

ON  THE 

DEEP  JYERFES  OF  THE  HEAD. 


BEFORE  the  student  commences  this  dissection,  he  should 
furnish  himself  with  a  mallet  and  chissels,  small  saws,  pin- 
cers, delicate  hooks,  and  a  magnifying  glass.  He  should 
also  have  the  base  of  a  scull  always  lying  before  him. 

The  manner  in  which  the  nerves  arise  from  the  brain,  has- 
been  pointed  out  at  page  170. 

The  1st,  or  Olfactory,  passes  into  the  cribriform  plate  of 
the  ethmoid  bone, — but  its  structure  is  generally  so  soft,  that 
we  cannot  trace  its  filaments. 

The  lid,  or  Optic,  we  see  entering  into  the  foramen  opti- 
cum.  We  shall  afterwards,  in  the  dissection  of  the  eye,  find 
that  it  passes  forward,  without  giving  off  any  branches  ;— • 
but  to  be  expanded,  as  the  Retina,  in  the  interior  of  the  eye.* 
We  should  now  take  hold  of  the  dura  mater  which  lies  upon 
the  frontal  bone,  with  the  pincers,  or  strong  hook,  and  pull  it 
off,  towards  the  temporal  and  sphenoid  bones.  This  requires 
some  force, — but  it  must,  at  the  same  time,  be  carefully 
done,  particularly  near  the  edges  of  the  foramen  lacerum,  or 
we  shall  tear  off  some  of  the  small  nerves  which  pass  into 
the  orbit.  Indeed,  the  third,  and  the  fourth  (which  lies  in 
the  sphenoidal  fold)  should  be  partly  exposed  before  the  dura 
mater  is  torn  down. 

When  the  membrane  is  torn  from  the  sphenoid  and  tempo- 
ral bones,  the  Ga-sserian  Ganglion  of  the  Vth  will  be  seen, — 
from  which  there  pass  off  the  three  grand  divisions,  viz.  the 
Ophthalmic,  passing  through  the  foramen  lacerum,  into  the 
orbit, — iheJSuperior  Maxillary,  through  the  foramen  rotun- 
dum,  to  the  upper  part  of  the  face, — and  the  Inferior  J\laxilla~ 
ry,  (which  is  divided  into  the  dental  and  gustatory,)  through 
the  foramen  ovale. 

The  first  nerves  to  be  followed,  are  those  which  pass 
through  the  foramen  lacerum  into  the  orbit,  viz.  the  third* 
the  fourth,  thejirst  division  ofthejifth,  and  the  sixth. 

*  Before  exposing  the  course  of  the  nerves  which  pass 
through  the  several  foramina,  we  should  attach  coloured 
threads  to  them,  by  which  we  shall  easily  find  them>  during 
the  course  of  the  dissection. 


270 

Before  we  can  trace  these  nerves,  the  orbit  must  be  open- 
ed, by  carrying  the  saw  through  the  orbitary  plate,  in  a  line 
drawn  from  the  middle  of  the  foramen  opticum,  to  the  inner 
angle  of  the  superciliary  ridge,  keeping  about  half  an  inch  t6 
the  temporal  side  of  the  crista  galli.*  The  os  mala?  is  then 
to  be  cut  to  the  depth  of  three-quarters  of  an  inch,  on  a  lev- 
el with  the  zygomatic  process.  The  saw  is  then  to  be  car- 
ried through  the  temporal  process  of  the  sphenoid  bone,  and 
the  squamous  part  of  the  temporal,  nearly  to  a  level  with  the 
sella  turcica.  By  a  smart  blow  with  the  mallet,  the  roof  of 
the  orbit  will  now  be  so  loosened,  that  by  cutting  close  upon 
the  bone,  it  may  be  entirely  detached  from  the  soft  parts. 

We  shall  now  have  so  exposed  the  orbit,  that  we  may  make 
the  dissection  of  the  nerves  in  it. 

The  first  nerve  which  will  be  seen,  is  a  branch  of  the 
ophthalmic  division  of  the  Vth.  It  is  the  same  which,  in 
the  dissection  of  the  face,  was  found  coming  through  the  su* 
perciliary  hole,  to  be  distributed  on  the  forehead.  A  black 
hair  pin  should  be  put  under  it  to  mark  its  situation.  In 
tracing  it,  we  shall  find  that  it  gives  off  two  principal  branch- 
es?,— one  to  the  lachrymal  gland,  and  the  other  to  the  nose. 
This  last  one  should  be  marked  by  a  bristle  or  pin,  as  it  must 
afterwards  be  minutely  traced. 

As  the  IVth  is  very  small,  we  should  first  look  for  the 
trochlearis  muscle,  upon  which  it  is  distributed,  and  then 
we  shall  see  some  of  its  fibres.  By  tracing  them  back,  we 
shall  discover  the  trunk  of  the  nerve,  which  is  not  larger 
than  a  thread.  The  third  will  be  found  at  its  entry  into  the 
orbit,  lying  very  close  on  the  optic  nerve.  It  almost  imme- 
diately divides  into  several  branches,  one  of  which,  in  its 
course  towards  the  obliquus, — and  at  about  three  quarters 
of  an  inch  from  the  foramen  opticum, — and  on  the  temporal 
side  of  the  optic  nerve,  will  be  found  to  form  a  union  with 
the  nasal  branch  of  the  Vth,  (already  described,)  through  the 
medium  of  a  small  ganglion  whch  is  called  the  Lenticular. — 
Prom  this  ganglion,  a  number  of  small  nerves  pass  into  the 
coats  of  the  eye  : — these  are  called  the  ciliary  nerves. 

The  sixthis  the  last  nerve  of  the  orbit,  to  be  dissected.  It 
enters  upon  a  lower  level  than  any  of  the  others ;  and  it  passes 
through  that  spongy  structure  of  the  dura  mater,  which  is 
railed  the  cavernous  sinus,  there  is  an  intimate  connexion  be-4 
tween  it  and  the  sympathetic, — but  this  union  will  be  more 

*  It  is  presumed,  that  the  dissection  of  all  the  superficial 
nerves  has  already  been  made  ;  and  that,  therefore,  there  can 
be  no  hesitation  in  cutting  through  some  of  the  superficial 
branches  of  the  Vth,  and  of  the  Vllth. 


271 

particularly  described  presently*  The  trunk  of  the  nerve 
will  be  found  to  be  almost  entirely  distributed  upon  the  rec- 
tus  externus  muscle.* 

We  must  now  follow  the  other  branches  of  the  Vth  pair. 
This  we  shall  find  to  be  a  most  difficult  dissection, — and  one* 
in  which  we  are  often,  after  much  labor,  foiled,  by  an  un- 
lucky blow  of  the  mallet  and  chisel,  f 

*  In  dissecting  the  nerves  of  the  orbit,  we  should  disturb 
the  natural  situation  of  the  parts  as  little  as  possible  ;  and  af- 
ter the  dissection  of  each  twig,  we  should  mark  it,  by  putting 
a  black  pin  or  bristle  under  it. 

f  Mr.  Bell  has,  in  his  late  lectures  on  the  nervous  system, 
shown  that  all  the  spinal  nerves,  the  suboccipital  and  the  Vth, 
have  several  essential  circumstances,  in  common :— that  they 
have  each  two  distinct  roots, — that  they  have  each  a  ganglion 
on  one  of  their  roots, — that  they  are  all  exquisitely  sensi- 
ble,— that  they  are  all  distributed  to  the  muscular  frame,  for 
locomotion  and  action, — that  each  nerve  is  distributed  to  its 
corresponding  division  of  the  bodily  frame,  without  ever 
taking  a  longitudinal  course  on  the  body, — and  finally,  that 
these  nerves  are  common  to  all  animals  which  have  a  symme- 
trical body  and  a  regular  nervous  system.  This  view  will 
more  easily  be  understood,  by  referring  to  the  plan  in  plate  I. 

When  we  examine  the  origin  of  the  nerves  minutely,  we  shall 
fmd  that  the  Vth  is  the  only  nerve  of  the  scull  which  comes 
oiFin  such  critical  circumstances,  as  to  have  a  root  from  the 
crus  cerebri,  and  another  from  the  crus  cerebelli, — which 
parts  may,  by  comparative  anatomy,  be  proved  to  be  the 
continuations  of  the  anterior  and  posterior  divisions  of  the 
spinal  marrow.  The  Vth  will  also  be  found  to  be  the  only 
nerve  within  the  scull,  which  has  a  ganglion  at  its  roots. 
Those  who  have  dissected  the  deep  nerves  of  the  head,  or 
who  have  attempted  to  demonstrate  the  branches  of  the  Vth 
pair  to  students,  will  be  able  to  estimate  the  value  of  thin 
view. 

I  have  examined  the  nerve  repeatedly,  in  its  whole  course, 
in  man,  in  the  horse,  the  ass,  the  calf,  and  the  dog.  By 
these  dissections,  I  have  been  convinced,  that  in  every  re- 
spect, the  Vth  pair  resembles  the  spinal  nerves,  even  in  thr 
peculiar  form  of  its  ganglion  and  plexus.  In  the  horse,  therp 
is  as  distinct  a  plexus  formed  by  the  branches  of  this  nerve 
which  go  to  the  different  parts  of  the  head,  as  there  is  form- 
ed by  those  which  go  from  the  axilla  or  loins  to  supply  the 
limbs.  I  conceive,  also,  that  the  form  of  the  part  from 
which  this  nerve  arises,  is  analogous  to  that  of  the  spinal 
marrow  where  t}ie  axillary  nerves  take  their  origin.  If  this 


272 

The  eye,  with  its  muscles,  nerves,  &c.  may  be  remove 
*ir  drawn  aside. 

The  zygomatic  process  of  the  temporal  bo#e  is  to  be  cut 
through  at  its  roots, — so  is  the  malar  process  of  the  superior 
maxillary.  When  the  intermediate  portion  of  bone  is  re- 
moved, we  may  easily  trace  the  superior  maxillary  of  the 
Vth,  across  the  spheno  palatine  fissure,  to  the  orbital  canal 
of  the  superior  maxillary  bone, — from  which  it  emerges,  at 
the  infra  orbital  foramen,  upon  the  face. 

In  its  passage  across  the  spheno  palatine  fissure,  it  gives 
off  some  important  twigs  ; — but  before  we  can  show  these, 
we  must  remove  a  great  deal  of  the  pterygoid  muscles.  By 
then  looking  close  upon  the  bone,  we  shall  see  a  confused 
plexus ;  which,  however,  will  be  found  to  be  principally 
made  by  the  branches  of  the  internal  maxillary  artery  ; 
therefore,  as  many  as  possible  of  these  vessels  are  to  be  re- 
moved :  we  shall  then  discover  two  twigs,  passing  down  to 
the  narrowest  part  of  the  fissure,  to  be  united  with  a  small 
ganglion,  which,  from  the  name  of  the  German  professor 
who  first  described  it,  is  called  the  ganglion  of  Meckel ;  or, 
from  its  situation,  the  spheno  palatine  ganglion. 

When  this  ganglion  is  carefully  examined,  some  branches 
will  be  seen  passing  off  from  it  towards  the  palate  and  nose; 
and,  from  its  back  part,  a  nerve  may,  but  with  some  trouble, 
be  seen  passing  into  the  pterygoid,  or  Vidian  hole  of  the 
sphenoid  bone.  This  nerve  (the  Vidian]  passes  to  unite 
with  branches  of  the  sympathetic,  and  with  theportio  dura  ;* 
but  it  cannot  be  traced,  until  those  of  the  other  division  of 
the  fifth  are  examined. 

•  be  correct,  it  will  be  another  proof  of  the  similarity  of  the 
Vth  nerve  to  the  spinal  nerves. 

In  this  investigation,  I  have  been  able  to  correct  the  very 
Common  mistake,  that  the  sympathetic  nerve  has  its  prinei- 
tjonnexion  with  the  nerves  of  the  head,  through  the  Vltli 
nerve. 

.The  branches  of  the  sympathetic,  which  appear  to  go  to 
the  VIth,go  to  the  ganglionic  portion  of  the  Vth. 

By  the  establishment  of  this  fact,  it  is  proved,  that  even 
the  connection  between  the  sympathetic  and  the  Vth,  is  sim- 
ilar to  the  union  of  the  sympathetic  with  the  ganglionic  roots 
of  the  spinal  nerves. 

For  an  account  of  the  experiments  by  which  the  similarity 
of  the  Vth  and  spinal  nerves  is  further  proved,  I  must  refer 
to  a  paper  in  the  Philosophical  transactions  of  the  present 
year. 

*  See  what  is  said  on  the  portio  dura?  p.  256. 


273 

The  third  division  of  the  Vth  is  BO  large,  that  we  shall  at 
once  see  it  by  looking  to  the  foramen  ovale.  To  make  if 
distinct,  after  it  has  passed  through  the  hole,  it  is  only  ne- 
cessary to  dissect  carefully  in  the  remaining  part  of  thf 
pterygoid  muscles.  The  branches  which  pass  to  the  supply 
of  these  muscles,  and  to  the  temporal  muscles,  will  then  bo 
seen.  It  is  presumed  that  the  jaw  bone  has  been  removed 
in  the  first  dissection,  and  that  the  dental  branch  is  marked 
by  a  thread  being  attached  to  it.  The  only  particular  branch 
of  this  nerve  that  remains  to  be  shown,  is  that  which  passe? 
back  from  the  gustatory  towards  the  glenoid  fissure,  (the 
corda  tympani*).  This  nerve  may,  with  some  care,  be  traced 
through  a  small  hole  into  the  cavity  of  the  tympanum;  but 
in  breaking  up  the  bone,  which  it  is  necessary  to  do  to  ex- 
pose its  course, — it  is  generally  torn.  Its  track  across  thf 
membrane  of  the  tympanum,  may  be  easily  shown,  by  break- 
ing up  the  cavity,  in  the  manner  recommended  in  the  dissec- 
tion  of  the  ear. 

The  foregoing  is  but  a  very  slight  sketch  of  the  manner  of 
dissecting  the  branches  of  the  Vth  pair  ;  but  I  hope  the 
hints  will  be  sufficient  to  enable  an  ingenious  dissector  to 
follow  the  branches  to  their  termination. 

The  Vllth  pair  will  be  seen  passing  into  the  foramen  au- 
ditorium internum, — where  it  almost  immediately  divides  in- 
to the  two  divisions,  Portio  Moll-is  and  Portio  Dura.  The 
portio  mollis  is  distributed  entirely  upon  the  organ  of  the  ear. 

As  the  portio  dura  passes  through  the  very  dense  part  of 
the  petrous  portion  of  the  temporal  bone,  it  "is  exceedingly 
difficult  to  follow  ;  but,  with  some  care,  it  may  be  done, — 
and  then  we  shall  find  the  union  between  it  and  the  Vidian, 
and  also  with  that  which  is  called  the  corda  tympani.f  The 

*  See  the  note  upon  the  portio  dura. 

f  In  the  investigation  of  the  minute  anatomy  of  the  portia 
dura,  or,  as  it  is  called  by  Mr.  Bell,  the  respiratory  nerve  of 
the  face,  we  have  been  induced  to  consider  the  Vidian  as 
that  branch  of  the  portio  dura  which  passes  to  the  respiratory 
muscles  in  the  back  part  of  the  palate,  and  to  the  membrane 
of  the  nose  ;  and  the  corda  tympani,  as  the  twig  which  sup- 
plies the  levator  and  tensor  palati  muscles :  I  think  we  may 
now  be  permitted  to  say,  that  these  two  nerves  have  hither- 
to been  traced  back  from  the  Vth,  only  in  consequence  of 
their  forming  a  union  with  the  deep  branches  of  the  Vllth, 
similar  to  that  which  is  formed  by  the  superficial  branches  of 
the  same  nerves  on  the  face. 

The  dissection  of  the  nerves  in  the  horse  would  lead  us  to 


1171 

.  e  will  bo  found  to  emer<ro   from  the  stylo   masloid 
men,  and  bo  distributed  on  tlio  face,  as  has  already  been  do 
scribed. 

believe,  that  branches    from    tho    sympathetic    pass    into  the 
Bar,  alnu^-  the  Vii'ian  ;   and  thai  branches  from  tho  Yth,  en 
tor  alomv  with  tho  corda  tynipam. 

Tho  portio  <lnra  will  ho  found  to  In-  0110  of  tho  most  iut.or- 
ostinn;  in  tho  nervous  astern  ;   ll»r,  hy  eomparal  i\  o  anatomy. 

we  are  able  to  provo,  that  it  exists  only  where  there  is  a  par- 
ticular respiratory  apparatus  eriments,  il 

boon  most  di-Minotlv  shown,  that  whon  this  norvo  is  out,  <  he 
muscles  to  wlr  muscles  of  rose 

Tion.      tf the  late  discoveries  by  Mr.  Boll    had    done  nothing 
more  than  to  show   tho    lueH'tlns    norvo,    thoy  \vt>uli  i 
havo  ronstitntod  t'c  mce  \vhioh   phy,- 

inad(x  in  tho  proson.t  day. 

Tho   vory  ourio'i  Mits   which    \voiv    in:  t itn'od  h\ 

him  to  investigate  fho  use  «»f  'his  IKTVO,  \vill  ho  foinul  in  tlit1 
rhilos(>phic;il  Transactions. 

Tho  compriiv.tive  anatomy  of  f!;oporlia  <!uia  is  vory  intor- 
ostino-;   hut  1  cannot    ontor  info  it.      H«>wo\rr,  1  shall  i. 
diico  tho  following  observations  on  its  distribution  in  tho  olc- 
pbant  :  — 

'During  tho  last    winter,    when    engaged   in    as.visfmcr  !\| .-. 
Hell  in  the  investigation  oft!  .-\s{i»m,  ! 

HM!  tho  me-  nge,  to  study  t!' 

and  use  of  the  prohosri>  of  th  il  :   and'  tins  I    i 

H'ood  oj>portunity  of  <!oin--  ;:iall  olophant.  WHS  so  \o 

>utlo,  that   he  permitted  metO  l;::.n  'Io  his  trunk  tree' 
Prom  the  o-rea!  power  which  the  elephant  has  over  his  triuik, 
'Machine,  I  '.-d  that  there  must  be  lan'.'e  nerves 

running  to  it,  similar  to  thoso  which  supply  the  , 

?uan  :   hut  as   the    n  an    i:up<-rhint  part  in  tho 

respiratory  system  oi  ,-i:il,  I  thought  tluif  in   tin1 

•re  would  be  t!io  mpsl 

curacy  or  faHnev  of  opinir-n  on  tho  |>orlio  dura. — 

Tho    animal    died     in   Hie   month    of  May  :    and,     through 
the  kindnt^s  of  my  fn  Mid,    Mr.  IVinvo,  WMO  pnrohasod  if 
dy  forthopurp  lection,    I  was  enabled  t.o  m.iK 

examination  of  thononvx  <if  the  trunk.  rj'lio  dissootion  \\  as 
jiiost  salisf,i»Mory  ;  for  tho  trunk  was  found  to  he  supplied 
not  only  by  branches  of  t  !io  Vlh  p;< :  'hod  b\('u\  icr, 

but  also  by  an  immense  branch  from  tho  portio  dura. 

Tlie  portio  dura  in  this  elephant  was  found  emerging ffOltl 

•  ho  parotid  «rtan.il,  as   in    other  mammalia.      It  j;avo  oiV  some 

.  ndin-v  hranclics  to  tluMiook,  \vhiloill   the  parotid  :  but 


275 

t  part  of  the  spinal  marrow  should   I 

oe  all  the  branch 
.'1th  pair.     This  may 
behind  the  rrmstoid  processes  of  the  temporal  bone, — and 

g  through  the  trans  v- 
vical  vertebrae,  with  a  mallet  and  a  y>/ir// 
the  broken  processes  are  to  be  torn  off  with  a  strong  pa 
nippers. 

heath  of  the  spinal  marrow  v; ill  then  be  expo 
When  it  i~  opened,  we  -hall  see  the  origins  of 

arid  the  trunk,  passing  up  to  unite  with  the  fib.-- 
the  par  van-urn  and  glosso  pharyngeal,  which  have 

- 

be  traced  through  the  foramen  lacenim,  with   th- 
jugular  vein.     As  soon  ^  they  emerge  from  the  scull. 

rate.     The  par  :]  be   found  to  form 

ganglion,  just  at  its  exit  from  the  scull. 

it  passed  from  behind  the  jaw  to  th  '  as  an 

entire  nerve,  and  of  the  size  of  the  sciatic  nerve  in  man 
in  its  .:ail  branches  to  th' 

muscles  of  the-  the   ear. — and  to   a  .- 

muscle  which  corresponds  with  the  platysma. 

Before  it  passed  into  thesul;.-  *.iie  proboscis,  it  . 

ted  with  the  second  division   of  the  Vth  paii.  which  c 
out  from  the  infra  orbital  hole,  in  two  large  branc 
two  nerves  being  then  closely  u;; 
layers  of  aich  form  the  greater  part  of  the  tr 

The  portio  dura  became  quickly  diminished  in  size.  : 
gave  off  its  branches  in  great  to  the  muscles  : 

the  Vth  was  contin-  .-ery  large  nerve,  to  nearly 

the  extremity 

nerv  :gers  in  rnan.     Onmaki::;. 

boscis,  near  its  extremity,   a  great  number  of  these  n 
were  seen  in  if  .ce. 

A  few  branches  of  the  portio  dura  ran  to  the  valvular  ap- 
paratus in  the  upper  part  of  the  trunk  :  but  this  peculiar 

pair,  which  was  about  the  size  of  the  radial  nerve,  and  v. 

jit  from  the  nriin  br 

The  exam,  me  animal  who- 

bosci  r.  and  n< '  ane  time  a  resr-i: 

gan,  would  rr 

;y  at  pro- 

sent  be  taken  cs  a  proof,  that  wh^re  the  par' 
an  or^  no  portio  dura. 

i  veryT  remarkable    nerve.     In    all  animals  in 


276 

The  IXth  pair  will  be  found  to  come,  by  a  single  set  of  fil- 
aments, from  the  corpus  pyramidale, — and  to  pass  through 

which  it  is  found,  it  is  intimately  connected  with  the  respira- 
tory nerves. 

If  an  animal  does  not  perform  part  of  the  act  of  respira- 
tion by  muscles  which  run  from  the  scull  to  the  chest,  no 
spinal  accessory,  or  superior  external  respiratory,  as  it  is 
called  by  Mr.  Bell,  will  be  found.  A  common  example  of 
this  may  be  seen,  in  any  of  the  larger  birds,  as  the  swan,  &c« 
By  experiments  on  the  ass,  we  have  proved,  that,  by  cut- 
ring  this  nerve,  we  can  paralyze  the  muscles  to  which  it  goes, 
AS  muscles  of  respiration,- — though  the  same  muscles,  being 
still  supplied  by  other  nerves,  will  retain  their  powers  of 
raising  the  head,  &c. 

During  the  month  of  April  last,  there  was  an  excellent 
opportunity  aiforded  of  corroborating  the  opinions  which 
JVIr.  Bell  has  formed  on  the  use  of  this  nerve,  by  the  dissecj 
lion  of  the  Courier  Camel,  or  Maherry,  which  was  brought 
from  the  interior  of  Africa  by  Captain  Lyon,  as  a  present 
to  his  Majesty.  In  the  dissection  of  this  animal,  \Ve  noticed 
many  interesting  facts,  which  have  been  overlooket!  by  com- 
parative anatomists, — and  particularly  the  distribution  of  the 
nerves  of  the  neck  and  stomach.  The  arrangement  of  the 
nerves  which  combine  the  muscles  of  the  throat  and  stom- 
ach, in  the  act  of  rumination,  is  very  beautiful.  But  at  pre- 
sent I  shall  confine  my  remarks  to  the  spinal  accessory,  or 
superior  respiratory  nerve. 

The  structure  of  the  neck  of  the  camel  is  very  different 
from  that  of  the  horse  or  bullock. — It  more  nearly  resembles 
that  of  a  large  bird,  such  as  the  swan,  to  which,  in  the  slow 
and  successive  motions  of  the  head,  it  has  a  great  resem- 
blance. Although  we  discovered,  by  dissection,  that  there 
was  a  great  similarity  in  the  muscular  apparatus  of  the  neck, 
to  that  of  birds,  we  did  not  expect  to  find,  that  the  arrange- 
ment of  certain  nerves  would  also  correspond;  and,  at  first, 
we  were  rather  suprised  that  we  could  not  find  a  spinal  ac- 
cessory nerve  in  union  with  the  VIHth,  under  the  jaw,  as 
we  had  found  in  all  the  other  quadrupeds  which  we  had  ex- 
amined. However,  on  comparing  the  muscles  of  the  neck, 
with  those  of  the  horse,  a  great  difference  was  found;  for. 
although  there  was  the  sterno  maxillaris,  which,  in  the  horse, 
receives  the  greater  part  of  the  spinal  accessory,  yet  it  was 
so  small,  that  it  could  have  no  power  over  the  motions  of 
the  chest,  as  it  has  in  the  horse,  ass,  &c.  In  the  lower 
part  of  the  neck,  there  are  several  muscles  corresponding 
to  the  scaleiu,  which,  besides  the  common  cervical  nerves 


277 

the  foramen  condyloicteum,  direct  to  the  inuscles  of  the 
tongue. 

We  may  now  examine  the  manner  in  which  each  cervical 
nerve  .arises  from  the  spinal  marrow.  We  shall  find  that 
each  nerve  has  a  double  root,  i.  e.  one  from  the  anterior,  and 
the  other  from  the  posterior  column  of  the  spinal  marrow  ; — 
that  the  one  from  the  posterior  has,  immediately  before  it 
joins  with  the  anterior,  a  ganglion  formed  upon  it  ;*  and  if 
rve.  carefully  examine  this,  we.  shall  find,  that  from  each 
ganglion  a  small  nerve  is  sent  off  to  unite  with  the  sympa- 
thetic, f 

To  trace  the  sympathetic  through  the  foramen  caroticum, 
and  to  show  its  connexions  with  the  nerves  within  the  scull, 
it  will  be  necessary  to  sacrifice  the  greater  number  of  thu 
other  branches.  When  the  foramen  caroticum  is  opened,  u, 
plexus  of  nerves  will  be  found  surrounding  the  carotid  arte 

receive  a  blanch  which  arises  in  common  with  the  phrenic. 
By  this  nerve,  these  inuscles  are  probably  combined  in  ac- 
tion with  the  other  muscles  of  respiration  ;  while  the  mus- 
cles on  the  upper  part  of  the  neck,  from  their  comparative 
size,  appear  to  be  of  as  little  use  in  producing  respiratory 
motions  of  the  chest,  as  those  of  a  bird  ;  and  this,  we  may 
be  allowed  to  presume,  is  the  reason,  why  there  is  no  spinal 
accessory,  or  superior  respiratory  nerve, — but  only  a  branch, 
rising  in  union  with  the  phrenic,  to  supply  the  respiratory 
muscles  on  the  lower  part  of  the  neck. 

*  Some  curious  experiments  have  been  made  in  Windmill- 
street,  on  the  comparative  degree  of  sensibility  of  the  two 
origins  of  these  nerves. .  Though  in  these  experiments  there 
was  sufficient  observed  to  induce  us  to  believe  that  there  is 
much  difference  between  the  two  sets  of  fibrils,- — yet,  from 
the  difficulty  of  making  them,  the  facts  are  not  yet  so  distinct 
as  to  permit  us  to  mention  them. 

f  This  union  or  origin  of  the  sympathetic,  appears  to  have 
been  entirely  overlooked  by  Bichat.     He  has  described  tho 
ganglion,  but  not  the  nerve  of  communication.  Had  he  lived, 
ui  all  probability  he  would  have  investigated  the  anatomy 
farther  •,  and  then  he  might,  perhaps,  have  given  up  the  idea  of 
considering  the  sympathetic  as  a  part  entirely  distinct  from 
the  system  of  the  spinal  nerves.     It  is  a  striking  and  curious 
fact,  that  in  the  edition  of  his  Anatomic  Descriptife,  publish 
ed  in  1802,  the  editor  says  :  "  Nous  reprenions  ensemble  J«» 
systemenerveux  des  ganglions  et  c'etoit  le  soir  meme  ou  nous 
avions  commence  le  ganglion  cervical  superieur,  que  Bichat 
tit  cette  funeste  chute  qui  determina  sa  derniere  maladie." 
Z 


278 


ry,  which  appear  to  be  united  witlr  the  Vlth,  but 
when  carefully  traced,  will  be  found  to  pass  over  the  Vlth 
to  the  Casserian  ganglion  of  the  Vth.*  There  will  also  be 
branches  seen  passing  along  the  Vidian  nerve  towards  the 
ganglion  of  Meckel. 


DISSECTION 

OF  THE 

PARTS  OF  THE  JfOSE-dJVD  OF  THE  EAR. 


AFTER  having  finished  the  dissection  of  the  nerves,  Hi' 
scull  should  be  divided,  so  that  we  may  have  an  opportunity 
of  examining  the  nose,  and  some  parts  of  the  ear. 

The  section  of  the  scull  may  be  made  by  carrying  the 
saw  through  the  remaining  part  of  the  bones  of  the  head 
and  face,  in  a  perpendicular  line, — but  a  little  to  one  side  of 
the  septum  narium.  The  soft  palate,  &c.  is  to  be  cut  in  the 
same  direction.  Each  of  the  sections  will  afford  us  some  ve- 
ry useful  views, — particularly  if  the  pharynx  and  larynx  be 
left  attached  to  one  of  them.  Indeed  the  anatomy  of  the 
posterior  nares,  &c.  is  so  important,  that  the  student  should 
always  examine  it,  even  though  he  should  destroy  many  of 
the  small  muscles. 

The  eavities  of  the  nose  will  be  made  more' distinct,  by 
cutting  (in  one  of  the  sections)  through  the  superior  maxilla- 
ry bone,  immediately  below  the  orbital  plate,  and  by  contin- 
uing the  cut  in  the  same  line,  through  the  ethmoid  and  sphe- 
noid bones. 

*  Professor  Boch,  of  Leipsic,  and  M.  Cloquet,  of  Paris 
have,  in  prosecuting  the  minute  anatomy  of  the  sympathetic 
nerves,  discovered  a  small  ganglion  in  the  cavernous  sinus. 
This  I  have  often  seen  :  but  I  think  I  have  also  shown,  by 
the  dissection  of  these  nerves  in  the  larger  animals,  that  it  is 
quite  an  error  to  suppose  that  the  principal  connection  be- 
tween the  sympathetic  and  the  nerves  of  the  head,  is  through 
the  Vlth  pair.  By  an  attentive  examination,  it  will  be  found 
that  the  branches  of  the  sympathetic,  which  appear  to  unite 
with  the  Vlth,  pass  along  it,  and  unite  with  the  ganglionic 
portion  of  the  Vth.  The  branches  of  the  sympathetic  which 
actually  unite  with  the  Vlth.  are  very  small. 


279 

We  may  then  see  the  mucous  membrane  which  lines  all 
the  interior  parts  of  the  nose,  viz.  the  Schneuhrian  membrane; 
the  inferior  Spongy  bone  ;  the  labyrinth  formed  by  the  eth- 
moid bone ;  the  communication  between  the  cells  of  the 
frontal,  ethmoid,  and  sphenoid  bones:  immediately  above 
the  inferior  spongy  bone,  we  shall  see  the  opening-  into  the 
antrum  of  Highmore  L  and  below  the  bone,  the  passage  to 
the  lachrymal  sac.  On  the  other  section,  the  septum  narium 
will  be  seen  to  be  formed  by  the  union  of  the  perpendicular 
plate  of  the  ethmoid  with  the  vomer,  through  the  medium  of 
a  cartilage.  Bylookingto  the  posterior  part,  we  can  under- 
stand the  relation  o  <"  the  passage  between  the  back  part  of 
the  nostrils  and  the  throat — the  posterior  nares ;  and,  with  a 
little  care,  we  may  discover  the  Ei-stachian  tube,  which  leads 
into  the  cavity  of  the  Tympanum. 

We  may  now  take  an  opportunity  of  examining  the  gene- 
ral anatomy  of  the  ear. 

The  following  description  of  the  manner  of  dissecting  the 
ear,  will  perhaps  enable  a  young  student  to  acquire  a  gene- 
ral idea  of  the  relative  position  of  the  parts  composing  the 
organ.  To  comprehend  the  minute  anatomy,  requires  more 
opportunities  than  a  dissecting-room  generally  affords. 

The  muscles  of  the  cartilag-es  of  tiie  external  ear,  are  ge- 
nerally so  small,  that  unless  the  dissection  be  made  in  a  very 
ileshy  ear,  as  in  that  of  a  negro,  it  will  be  impossible  to  find 
them  ;  but  those  running  from  the  head  to  the  ear,  may  al- 
ways be  easily  found.* 

*  The  following  table  of  these  muscles  is  added : — 

MUSCLES  LYJNG  ON  THE  CARTILAGES  OF  THE 
EXTERNAL  EAR. 

HELICIS  MAJOR.  OR.  The  upper  and  acute  part  of  the 
helix,  anteriorly. 

IN.  Into  its  cartilage,  a  little  above  the  tragus. 

HELTCIS  MINOR.  OR.  The  inferior  and  anterior  part  of 
the  helix. 

IN.  The  crus  of  the  helix,  near  the  fissure  in  the  cartilage, 
opposite  to  the  concha. 

TRAGICUS.     OR.  The  middle  and  outer  parts  of  the  con- 
cha, at  the  root  of  the  tragus. 
IN.  The  point  of  the  tragus. 

ANTITRAGICUS.  OR.  The  internal  part  of  the  cartilage 
t;hat  supports  the  antitragus. 

IN.  The  tip  of  the  antitragus,  as  far  as  the  inferior  part 
of  the  antihelix,  where  there  is  a  fissure  in  the  cartilage. 


The  several  cartilages  may  be  exposed  by  merely  rendering 
the  skin,  &c.  which  covers  them.  The  cartilaginous  tul* 
should  be  followed  down  to  the  bone.  The  squamous  pail 
of  the  temporal  bane  should  then  be  cut,  down  to  the  level 
of  the  pars  petrosa;  and  we  should  proceed  to  lay  open  the 
different  cavities  of  the  internal  ear. 

The  bone  immmediatcly  behind  the  squamons  portion,  and 
in. a  line  with  the  posterior  part  of  tfie  tube,  is  so  very  thin, 
that  the  slightest  blow  .with  a  small  chisel  will  break  it  :  if 
the  fracture  be  made  posterior  to  the  line  of  the  meatus  ex- 
,  ternus,  the  mastoid  cells  will  be  opened.  After  having  done 
this,  it  is  very  easy  to  expose  the  whole  cavity  of  the  tympa- 
num, by  breaking  up  the  thin  bone,  in  the  direction  towards 
the  foramen  spinale  of  the  sphenoid  bone. 

The  membrane  of  the  tympanum,  with  the  chain,  of  bones, 
vvill  now  be  seen,  and  also  the  communication  of  the  tympa- 
•mm  with  the  mastoid  cells ;  and  if  a  fine  probe- be  pushed  ta- 
wards  the  fere  part  of  the  cavity,  it  will  pass  into  the  Eu- 
stachian  tube ;  but  it  will  not  be  possible  to  push  the  probe  in- 

TRANSVERSUS  AURIS.  OR.  The  prominent  part  of  the 
concha  on  thedorsum  of  the  ear. 

IN.  Opposite  to  the  outer  side  of  the  antihelix. 

These  muscles  are  for  the  most  part  scarcely  discernible  : 
they  are,  no  doubt,  for  giving-  rigidity  to  the  ear,  the  bettr » 
to  enable  it  to  collect  the  sound. 

MUSCLES  OF  THE  EXTERNAL  EAR. 

ATTOLENS  AURIS.  A  thin  and  almost  tendinous  sheet. 
OR.- The  tendon  of  the  occipito-frontalis,  where  it  cove** 
the  ape-neurosis  of  the  temporal  muscle. 

IN.  The  upper  part  of  the  ear,  opposite  to  the  antihelix. 

ANTERIOR   AURIS.     A    membranous  muscle  also.     On- 
Back  part  of  the  zygomatic  process  of  the  temporal  bone. 
IN.  The  back  of  the  helix,  near  the  concha. 

RETRAIIENTES  AURIS.  Two  delicate  membranous  mus- 
.  rles.  OR.  The  mastoid  process,  above  the  insertion  of  the 
v^terno  cleido  mastoideus. 

IN.  That  part  of  the  back  of  the  ear  which  is  opposite  to 
« he  septum  that  divides  the  scapha  and  concha. 

These  muscles,  in  a  state  of  nature,  are  designed  to  give 
/tension  to  the  ear;  to  make  it  more  capable  of  receiving 
sounds,  and  especially  to»bring  us  acquainted  with  the  di- 
rection of  sounds  ;  but  their  use  is,  in  general,  almost  civ 
tirelv  lost. 


281 

be  throat,  without  injuring  the  little  bones  in'  the  tympa 
num, — the  tube,  therefore,  should  be  examined  in  the  throat. 

*  As  we  have  determined  to  sacrifice  the  bones,  for  the 
purpose  of  examining  the  eye,  nose  and  ear,  the  following 
cuts  should  be  made:t  the  lower  jaw  having-  been  removed, 
the  saw  should  be  carried  in  a  line  parallel  with  the  cavity  ot 
the  tympanum,  cutting  through  the  glenoid  cavity,  and  ter- 
minating in  the  foramen  ovale  of  the  sphenoid  bone  ;  another 
cut  (if  the  orbit  has  not  yet  been  opened)  should  pass  through 
the  os  malae,  at  its  union  with  the  superior  maxillary  bone, 
and  be  carried  in  a  'line  through  the  frontal  and  sphenoid 
bones,  so  as  to  meet  the  first  cut  into  the  foramen  ovale  ^ 
when  the  triangular  piece  of  bone  which  is  included  between 
these  cuts,  is  removed,  it  will  be  easy  to  show  the  whole  ex- 
tent of  the  Eustachian  tube ;  and  if  one  half  of  the  soft  pal- 
ate be  cut  away,  the  trumpet  mouth  of  the  tube  will  be  ex- 
posed ;  and  now  a  small  probe  (for,  at  one  point,  the  tubo 
is  very  narrow)  may  be  passed  into  the  tympanum ;  the  tube 
may  be  laid  open, "thro ugh  its  whole  length,  with  a  pair  of 
strong  scissars.     We  shall  now  be  convinced  of  the  imprac- 
ticability of  passing  a  probe  into  the  ear  from  the  mouth. — 
The  mere  possibility  of  doing  it  from  the  nostril,  will  be- 
seen. 

It  is  now  easy  to  understand,  that  if  the  Eustachian  tubf* 
be  closed,  after  an  ulcerated  sore  throat,  deafness  may  be  the 
consequence  ;  or  how  temporary  deafness  is  frequently  oc- 
casioned by  catarrh.  In  proof  of  the  cause  of  this,  we  shall 
iind,  that  in  children  who  die  of  cynanche,  the  tube  is 
generally  ftill  of  purulent  matter.  It  must  also  be  evident, 
that,  in  those  people  who  can  throw  smoke  from  the  mouth, 
out  by  the  ear,  tj|e  membrana  tympani  must  be  in  part  des- 
*royed. 

Besides  the  bones,  (the  Jifaleus,  Incus,  Orbiculare,  and 
Stapes,)  there  are  certain  small  muscles  within  the  cavity  of 
tlte  tympanum  ;  but  these  are  very  difficult  to  show.  On 
the  upper  part  of  the  Eustachian  tube,  a  muscle  lies,  partly 
ui  a  cavity,  which,  in  the  dry  bone,  being  something  like  a 
marrow-spoon,  has  been  called  the  Spoon-like  Cavity  ;  upon 
the  extremity  of  which,  the  tendon  of  the  muscle  is  reflected, 
and  then  runs  to  the  long  process  of  the  malleus.  This  mus- 
cle is  called  the  Tensor  Tympani.  From  the  opposite  sid( 
of  the  Eustachian  tube  and  glenoid  fissure,  another  muscle 

*  The  following  directions  for  cutting  the  bone,  were  writ- 
ten under  the  id£a,  that  the  dissection  of  the  ear  was  to  bt 
the  principal  object :  it  will  be  easy  to  vary  the  cuts  a  lit 

it"  the  posterior  flares,  &c.  have  already  been  examined, 


232 

passes,  to  be  inserted  into  the  malleus ;  it  is  the  Laxaiur 
Tympani.  From  the  upper  part  of  the  tympanum,  there  is  & 
thira  muscle,  which  runs  to  the  short  process,  and  is  called 
the  Superior  or  External  muscle  ;  but  this  last,,  is  denied  by 
many  to  be  of  the  nature  of  muscle.  There  is-  still  a  very 
small  muscle  attached  to  the  stapes, — it  is  called  Stapedius, 
and  takes  an  origin  from  the  interior  of  a  little  eminence,  ab- 
surdly called  pyramid.  The  corda  tympani  nerve,  which  has 
already  been  described  at  page  273,  will  be  seen  running 
across  the  membrane  of  the  tympanum,  and  over  the  long 
process  of  the  malleus. 

Although  these  muscles  are  now  mentioned,  it  is  not  pos- 
sible to  see  them,  all  in  this  stage  of  the  dissection,  as  the 
tympanum  has  not  yet  been  sufficiently  opened ;  but  to  ex- 
pose it  more  at  present,  for  the  purpose  of  exhibiting  these 
muscles,  would  endanger  the  parts  composing  the  labyrinth* 

It  is  almost  imposible  for  any  one  but  an  experienced  dis- 
sector ,.  to  exhibit  all  the  parts  of  the  labyrinth,  in  one  view. 
To  do  this,  he  must  have  a  knowledge  of  each  part ;  and  to 
expose  them,  he  requires  a  variety  of  little  instruments,  as 
small  chisels,  files,  and  saws  ;  but  it  is  possible  for  any  one 
to  make  such  a  dissection,  as  will  give  a  general  idea  of  the 
relative  situation  of  the  parts.  About  a  quarter  of  an  inch 
posterior  to  the  meatus  internus,  a  ridge  will  be  seen  cross- 
ing the  petrous  portion  ;  if  this  surface  be  fried  down,  a  ca- 
vity will  be  opened,  viz.  the  Superior  Semicircular  Canal. 
This  canal  may  be  easily  followed,  by  putting  an  awl  into  its 
cavity,  and  then,  as  with  a  lever,  breaking  up  the  bone :  bv 
tracing  it  towards  the  cavity  of  the  tympanum,  we  shaft 
show  its  communication  with  the  Horizontal  Canal ;  by  tra* 
cing  its  oth^r  end,  we  shall  open  the  Internal  Canal;  but  it 
is  very  difficult  to  follow  these  two  last  carlals  through  their 
whole  extent.  The  Vestibule  may  be  opened  by  breaking 
the  bone  with  a  small  chisel,  immediately  anterior  to  the 
union  of  the  superior  and  external  semicircular  canals,- — or  a. 
better  mark,  is  the  base  of  the  Stapes  ;  but  in  making  the 
cut,  we  are  very  apt  to  break  up  the  foramen  ovale;  To 
show  the  Cochlea,  a  slanting  cut  should  be  made  across  the 
meatus  internus,  towards  the  Eustachian  tube.  If  this  be 
done  with  a  very  fine  saw,  it  will  probably  pass  through  the 
Modiolus,  so  as  to  give  a  view  of  all  the  parts  of  the  cochlea; 
but  in  making  the  cut,  the  ssrw-dust  will  so  fill  the  Scales 
Cochiece,thai  it  will  be  impossible  to  see  them  until  they  are 
cleaned  ;  but  we  must  not  put  any  instrument  into  the  coch- 
lea to  clean  it ;  it  should  be  done  by  dipping  the  preparation 
into  water,  and  blowing  forcibly  into  the  scalae  with  a  bl 
We  may  then,  perhaps,  make  the  Modiolw  and 


283 

miua  Spiral™,  with  the  bifundibulum,  distinct.  I  shall  noi 
imter  into  a  more  minute  description  of  the  parts,  but  shall 
refer  the  student  to  go'od  books  of  anatomy ;  he  will  find 
threat  assistance  in  the  Plan  of  the  Ear,  published  by  Bur- 
gess and  Hill,  and  which  is  copied  from  the  drawing  used  in 
Windmill-street,  for  the  demonstration  of  the  internal  struc- 
ture of  the  ear. 


DISSECTION 

OF 

THE  E  YE, 


As  the  parts  of  the  human  eye  are  not  only  on  a  small 
scale,  but  as  we  can  seldom  procure  them  sufficiently  fresh 
for  the  dissection  of  the  minute  parts,  we  should  have  much 
difficulty  in  acquiring  a  knowledge  of  the  structure  of  the 
eye,  as  an  organ  of  vision,  were  it  not  that  we  have  it  always 
in  our  power  to  get  the  eyes  of  sheep,  pigs,  or  oxen,  in  t>. 
perfectly  fresh  state.  Indeed,  we  shall  find  it  advantageous 
to  dissect  the  eyes  of  some  of  those  animals,  before  we  exam- 
ine the  human  eye ;  because,  in  them  the  important  parts  oi 
the  organ  are  not  only  the  same,  but  they  have  this  great  su- 
periority over  human  eyes  for  dissection, — the  being  much 
larger.  But  to  understand  the  eye,  as  a  part  upon  which 
surgical  operations  are  to  be  performed,  we  must  carefully 
examine  the  human  eye,  and  accurately  mark  the  proportion- 
ate size  and  relative  position  of  each  part. 

It  need  hardly  be  said,  that  the  eye-lids,  and  the  lachry- 
mal apparatus,  muscles,  &c.  must  all  be  studied  on  tin* 
human  body. 

The  eye  of  a  sheep  is  a  very  good  subject  for  dissection  ; 
but  the  eye  of  a  pig,  in  some  respects,  more  nearly  resembles 
the  human  eye.  The  dissection-  of  the  eye  of  the  horse  or 
ox  will  be  found  very  useful  when  we  wish  to  examine  some- 
of  the  minute  parts. 

Before  endeavoring  to  discover  the  minute  structure  of  the 
eye,  we  should  make  several  sections,  to  acquire  a  general 
knowledge  of  its  parts.  We  may  commence  by  dissecting 
away  the  muscles,  &c.  which  are  attached  to  the  ball  of  the 
eye.  When  this  is  done,  the  Sclerotic  will  be  seen,  with  th# 


284 

transparent  Cornea  attached  to  its  anterior,  and  the  JV  mr< 
perforating  its  posterior  part. 

If  we  puncture  the  cornea,  the  Aqueous  Humour  will  es- 
cape :  if  we  cut  out  a  portion  of  the  cornea,  we  shall  see  the 
/m,  with  its  central  hole,  called  the  Pupil.  By  now  pres- 
sing on  the  ball  of  the  eye,  the  Lens  will  be  pushed  forward 
into  the  pupil :  by  scratching  with  the  point  of  the  knife,  we' 
shall  open  the  capsule  of  the  lens  ;  by  increasing  the  pressure 
on  the  ball,  the  lens  will  start  through  the  pupil,  and  then 
the  Vitreous  Humour  will  appear  pushed  forward  into  the 
pupil.  But  as  the  capsule  of  the  vitreous  humour  (tunica 
hyaloidea)  is  very  different  from  that  of  the  lens,  the  mere 
scratching  of  its  anterior  part  will  not  be  sufficient  to  evacu- 
ate the  humour ;  but  to  do  this,  the  instrument  must  be 
plunged  deep  into  it,  and  be  moved  in  several  directions  :  by 
then  squeezing  the  ball,  an  aqueous  humour  will  exude. 

Another  eye  may  now  be  cut  through,  at  half  an  inch 
posterior  to  the  edge  of  the  cornea.  On  the  ante* 
rior  section,  we  shall  see  the  back  part  of  the  iris,  of  a  deep 
black  colour :  the  transparent  lens  will  be  seen  lying  upon 
it.  On  the  posterior  half,  we  shall  see  the  transparent  vitre- 
ous humour  ;  and  looking  through  it,  we  shall  probably  see 
the  inner  surface  of  the  Choroid,  because,  in  a  very  fresh  eye, 
:  the  Retina^  which  is  interposed  between  the  vitreous  humour 
and  the  choroid,  is  generally  transparent ;  but  perhaps  some 
of  the  vessels  of  the  tunica  vasculosa  retina  may  be  seen,  ap- 
parently on  the  back  part  of  the  vitreous  humour.  When 
we  hold  up  this  portion  of  the  globe,  and  invert  it,  the  vitre- 
ous humour  will  fall  out ;  and  then  the  nervous  matter  ot* 
the  retina,  being  exposed  to  the  air,  will  become  opaque,  and 
consequently  visible :  but  it  will  not  keep  its  proper  posi- 
tion ; — it  will  fall  back  towards  the  bottom  of  the  eye,  so  ?>' 
to  expose  the  whole  of  the  inner  part  of  the  choroid,  which, 
in  the  sheep,  is  black  and  green.  The  choroid  may  now  bt 
easily  separated,  with  the  handle  of  the  knife,  from  the  scle- 
rotic. 

Before  we  commence  the  examination  of  the  minuf '< 
structure,  we  ought  to  fix  the  eye  ;  and  this  should  be  done 
in  such  a  manner,  that  we  may,  in  the  course  of  the  dissec- 
tion, be  enabled  to  put  the  eye  into  water, — for  there  are 
some  parts  too  delicate  to  be  dissected,  unless  they  are,  at  the 
same  time,  supported  in  a  fluid.  Anything  in  the  form  of  a 
small  egg-cup,  or  pill-box,  will  hold  the  eye  sufficiently 
steady  to  enable  us  to  examine  the  principal  parts  ;  but  we 
should  at  once  so  fix  it,  that  we  may  continue  the  dissection 
through  the  whole  organ.  The  most  convenient  mode  of 
fioing  this,  is  to  attach  the  ball  of  the  eye,  with  a  few  pins.,  tc 


285 

a  piece  of  cor-':,  about  an  inch  in  diameter,  and  half  an  iiicL 
in  depth,  which  has  been  previously  hollowed  out,  and  fixed 
to  a  saucer  with  sealing-wax.  The  pins  may  be  pushed 
through  the  coats  ;  or  it  will  be  better  to  put  the  pins  into 
the  cork,  and  then  to  pass  three  or  four  threads,  at  different- 
points  through  the  sclerotic,  about  half  an  inch  from  the 
,  nerve ;  the  threads  are  then  to  be  fixed  to  the  pins.  If  it  be 
too  much  trouble  to  make  this  apparatus,  two  small  nails, 
slightly  bent,  maybe  laid  across  each  other",  and  fixed  to  v. 
saucer  with  sealing-wax  ;  the  eye  may  then  be  easily  at- 
tached to  them.  Li  addition  to  the  saucer,  we  should  have 
a  glass  globe,  one  third  of  which  has  been  cut  off;  for  after 
the  parts  have  been  dissected,  they  will  be  seen  to  great  ad 
vantage  by  filling  this  globe  with  water,  and  then  inverting 
it  over  the  saucer:  the  manner  of  doing  this,  does  not  re- 
quire much  ingenuity  to  discover. 

We  may  now  proceed  to  make  a  very  minute  examination 
of  all  the  parts  already  mentioned. 

The  transparent  cornea,  and  the  sclerotic,  are  so  inti- 
mately connected,  that,  on  the  first  examination,  they  will 
appear  to  be  parts  of  the  same  coat ;  indeed,"  we  cannot  sep- 
arate them  ;  yet  by  maceration,  the  connexion  between 
them,  will  become  so  completely  loosened,  that  the  cornea 
will  fall  from  the  sclerotic,  like  a  glass  from  its  frame.-— 
Even  in  the  fresh  state,  we  can  show  that  they  are  of  dif- 
ferent textures.  To  do  this,  the  cornea  must  be  cut  from 
the  sclerotic  by  a  pair  of  sharp  scissars(in  doing  which,  the 
aqueous  humour  will  escape),  and  then,  by  taking  the  cornea 
betwixt  the  finger  and  thumb,  we  shall  feel  that  it  is  com- 
posed of  several  lamime,  between  which,  there  is  a  cellular 
structure,  filled  with  a  pellucid  fluid. 

If  we  squeeze  the  ball  of  the  eye,  before  the  cornea  is 
cut  off,  it  will  appear  opaque, — probably  in  consequence 
of  the  relative  position  of  the  cells  being  changed.  When 
the  pressure  is  taken  off,  the  eye  will  again  appear  clear ; 
this  explains  the  immediate  good  effect  of  puncturing  the 
cornea,  when  there  is  effuson  into  the  anterior  chamber. — 
This  operation  is  frequently  perfomed  on  horses.  The  cor- 
nea may  be  separated  into  distinct  lamina?;  but  this  will 
be  more  easily  done  after  it  has  been  macerated  sometime; 
we  shall  then  be  able  to  discover,  besides  the  proper  laminae, 
a  coat,  upon  the  external  surface  of  the  cornea,  which  appear* 
to  be  the  continuation  of  the  tunica  conjunctiva,-— -and  anoth- 
er, on  the  inner  surface,  which  has  sometimes  been  describ- 
ed as  a  capsule  of  the  aqueous  humour.  This  last  is  some- 
times called,  from  its  discoverer,  Tunica  Wrisbcrgii. 

It  would  be  inconvenient  to  examine  the  structure  of  tho 


286 

H'lerotic,  at  present :    we  may  defer  it  until  we  finish 
other  parts,  or  examine  it,  in  another  eye.     We  shall  find 
that  it  is  not  lamsllated,  but  fibrous. 

The  cornea  being  removed,  the  iris  will  be  seen. — It  is 
almost  needless  to  remark,  that  the  shape  of  the  iris  in  the 
sheep,  is  very  different  from  that  of  man. 

The  cut  edge  of  the  sclerotic  should  now  be  seized  with  , 
the  forceps.  Tlje  point  of  the  scissars  is  then  to  be  gently 
insinuated  under  it, — or  will  be  better  to  pass  an  ivory  or 
silver  probe  under  the  edge  of  the  sclerotic,  to  the  extent  of 
a  quarter  of  an  inch,  and  then  to  gently  move  it  round  the 
circle  ;  this  will  separate  the  connections  between  the 
sclerotic  and  Lignmentum  Ciliare,  which  is  the  name  given 
to  the  part  which  connects  the  choroid  and  iris. 

The  sclerotic  may  then  be  cut,  so  as  to  expose  the  outer 
part  of  the  choroid:  this  is  to  be  done,  by  first  passing  one 
blade  of  the  scissars  cautiously  between  the  two  coats,  and 
then  inclining  the  eye  to  one  side,  that  the  weight  of  the 
humours  may  so  drag  on  the  choroid,  as  to  facilitate  the  sep- 
aration. After  having  removed  a  small  portion  of  the  scle- 
rotic, it  will  be  well  to  put  the  saucer  into  a  flat  basin,  or 
dish,  with  as  much  water  in  it,  as  will  cover  the  eye.  The 
whole  of  the  sclerotic  need  not  be  removed,  but  only  as  much 
as  will  exhibit  the  external  appearance  of  the  choroid.  A 
number  of  small  nerves  and  vessels  will  be  found  running 
between  the  sclerotic  and  choroid,  which  ought  to  be  cut,— 
not  torn.  The  choroid  will  now  appear  to  be  of  a  jet  black 
colour,  which  is  owing  to  a  black  secretion  ;  yet  if  we  scrape 
Hie  membrane  with  the  finger,  very  little  colouring  matter 
will  come  off.  But  although  this  secretion  is  on  its  inner 
surface,  still  a  little  exudes  through  the  coat ;  for  even  in  a 
very  fresh  eye,  the  surface  of  the  sclerotic,  in  contact  with 
the  choroid,  will  be  slightly  discoloured. 

The  iris  will  now  be  more  distinctly  seen,  and,  between  it 
and  the  choroid,  the  white  ring,  which  has  received  many 
names,  viz.  ligctmentum  cilictre  ;  corpus  ci/iare  ;  annulus  lig-ci- 
mentosus ;  annulus  gangliformis  tunicce  choroidece  :  but  the 
name  most  commonly  given  to.  it,  is  Ligamentum  Ciliare. 

The  chorid  consists  of  two  lamuitB  : — by  cutting*  very 
carefully,  with  a  small  scalpel,  through  one  half  of  the  mem- 
brane about  the  middle  of  the  eye,  and  by  pulling  upon  the 
divided  portion  with  the  forceps,  we  may  show  both  of  the 
laminae;  but  it  is  difficult  to  do  this  nicely:  howrever,  we 
shall  at  once  be  able  to  understand  the  difference  between 
the  two  lamina?,  when  the  choroid  is  separated  from  the  re- 
tina  ;  for  then,  the- internal  surface  will  appear  of  a  bright 


287 

colour,  and  mllous^  —  while  the  external,  will  be  dull,  and 
cellular. 

The  external  part  is  called  the  true  choroid,  from  its  re- 
semblance to  the  chorion  of  the  fetus,  —  the  inner  part  has, 
in  honour  of  the  discoverer,  been  called  Tunica  Ruy&ckiana: 
The  variegated  colour  of  the  internal  surface,  in  some  ani- 
mals, having  some  resemblance  to  the  colour  of  fine  tapestry, 
has  induced  the  Parisian  dissectors  to  give  it  the  name  of 


Though  we  cannot  make  the  following  dissection  on  fhr 
same  eye  on  which  the  internal  part  of  the  choroid  has  beer? 
examined,  yet  the  description  may  now  be  given.,  The  cor- 
nea, and  half  an  inch  of  the  anterior  part  of  the  sclerotic,  IP 
to  be  carefully  removed  from  the  choroid  :  —  this  will  show 
the  iris  in  union  with  the  choroid,  through  the  medium  oi1 
the  white  body  called  ligamentum  ciliare. 

It  must  be  evident,  at  first  view,  that  the  iris  is  of  a  verx 
different  structure  from  the  choroid.  On  the  latter,  we  sec 
a  number  of  small  veins,  disposed  in  whirls  or  vortices, 
whence  the  name  vasa  vorticosa  ;  while  on  the.  iris,  we  can 
not  see  any  thing  resembling  them.  There  is  not  any  ap- 
pearance in  the  choroid,  of  fibres  ;  but  in  the  iris,  we  sec 
both  radiated  and  circular,*  —  which  have  been,  by  the  besl 
authorities,  supposed  to  be  muscular. 

The  colour  of  the  two  parts,  anteriorly,  is  also  very  differ- 
ent ;  for  the  name  of  iris  has  been  given,  from  the  variety  of 
•Colours  seen  upon  it.  When  the  anterior  .surface  is  exam- 
ined with  the  microscope,  a  number  of  tilli  will  be  seen. 
which  are  said  to  secrete  the  different  coloured  matters  ;  but 
when  the  back  of  the  iris  is  examined,  it  will  be  found  to  In- 
covered  with  the  pigmentum  r.igrum,  whence,  from  its  black 
appearance,  it  has  sometimes  been  called  uvca. 

So  far,  it  is  sufficiently  clear,  that  the  choroid  and  iris  arr 
very  different  from  each  other  ;  but  many  authors  havf 
said,  that  the  anterior  part  of  the  choroid  is  divided  into  two 
portions,  viz.  into  the  Iris  and  Ciliary  Processes.  But  J 
think  those  authors  must  have  come  to  this  conclusion,  in  con- 
sequence of  having  made  the  dissection  in  rather  a  superfi- 
cial manner.  To  understand  the  true  anatomy  of  the  part. 


*  The  pigment,  upon  the  surface  of  the  tapetum,  is  g<^ 
ally  black  in  men,  but  the  secretion  is  of  various  cojours,  in 
different  animals  ;  sometimes  it  is  deficient,  and  this   i> 
i  he  appearance  of  the  red  eye,  as  in  the  white  rabit,  cream 
Coloured  horse,  or  albino;  for  in  them,  the  blood  Circulating 
in  the  choroid,  is  seen  through  the  pupil,  while  in  the  com- 
mon eye,  the  vessel j?  are  obscured  by  the  pigmentv; 


288 

xvc  must  first  examine  the  ligament  by  which  the  iris  is  con- 
nected to  the  choroid.— In  the  fresh  eye,  it  is  so  firm,  that 
it  is  difficult  to  detach  the  iris;  but  after  the  eye  has  been 
macerated  for  some  time,  the  iris  may  easily  be  separated 
from  the  choroid,  and  then  the  ciliary  processes  will  be  seen. 
This  dissection  may  be  made  in  two  ways ;  the  first  may  be* 
done  in  an  eye  nearly  quite  fresh — After  the  iris  and  part 
of  the  choroid  have  been  exposed,  we  should  introduce  one 
blade  of  the  scissars  into  the  pupil,  and  cut  across  the  iris, 
(but  not  quite  to  its  root,)  at  two  sides  of  the  circle.  If  we 
then  tear  one  half  of  the  iris  back  towards  the  choroid,  we 
^hall  expose  the  black  circle  of  ciliary  processes,  lying  loose 
on  the  margin  of  the  capsule  of  the  lens  :  by  tearing  away 
this  portion  of  the  iris,  altogether  from  the  ligament,  we 
shall  see  that  these  processes  are  the  termination  of  the 
choroid. — To  expose  them  in  another  manner,  the  eye  should 
fee  two  days  old. — We  should  not  now  cut  the  cornea,  but 
through  the  circle  of  the  sclerotic,  about  a  quarter  of  an 
inch  from  the  margin  of  the  cornea. — We  must  not  injure 
the  choroid,  but  separate  the  sclerotic  from  it.  In  separa- 
ting these  two  coats,  the  iris  will  probably  adhere  to  th£ 
sclerotic  and  cornea,  so  that  when  it  is  torn  up,  the  ciliary 
jigament  will  be  divided  into  two  portions:  the  ciliary  pro- 
cesses will  be  seen  projecting  from  that  part  of  the  ligament 
which  remains  attached  to  the  choroid.  At  the  first  view, 
the  apices  of  the  processes  will  appear  to  adhere  to  the 
capsxile  of  the  lens, — and  so  they  have  been  described  by 
many;  but  that  they  do  not,  may  be  proved,  by  blowing  a 
little  air  between  them  and  the  lens:  this  will  also  show, 
that,  at  their  bases,  they  appear  to  adhere  to  the  capsule.; — 
but  they  do  riot  actually  touch  it,  for  there  is  interposed  be- 
tween them  and  the  capsule,  a  membrane.,  presently  to  be 
described  (Tunica  Vasculosa  Retinae).  This  part  of  thedis~ 
section  is  very  difficult,  and  ought  to  be  done  while  the  parts 
are  under  water.  There  is  still  another  method  of  giving  a, 
view  of  the  ciliary  processes. — This  is,  to  make  a  section  of 
the  anterior  part  only  of  the  eye,  at  the  distance  of  half  an 
inch  posterior  to  the  margin  of  the  cornea.  The  lens  will 
fee  seen  lying  on  the  iris,  and  beneath  its  transparent  margin, 
H  black  circle,  which  is  formed  by  the  ciliary  processes. 

To  examine  the  processes  still  farther  in  this  section,  the 
lens  ma.y  be  removed,  by  cutting  the  posterior  part  of  its 
capsule.  If  the  parts  be  ROW  put  in  water,  and  the  proces- 
ses be  scraped  with  the  handle  of  the  knife,  the  pigment 
which  covers  them  will  be  washed  away,  and  then  they 
will  have  the  form  of  a  circle  of  white  stride,  projecting  front 
"fr1  f'horoid.  and  parking  behind  the  iris. 


289 

As  the  retina  is  a  very  delicate  part,  considerable  care  is 
requisite  in  preparing  it  for  demonstration.  An  ey e  should 
be  properly  fixed  in  the  saucer,  and  the  chcroid  prepared  as 
has  already  been  described ;  then,  while  the  eye  is  under 
water,  a  part  of  the  choroid  should  be  torn  off, — the  white 
opaque  retina  will  then  be  seen.  But  there  is  anoiher  coat 
between  this  and  the  choroid,  which,  however,  is  so  delicate 
a  membrane,  that  it  is  almost  impossible  to  see  it  with  the 
Baked  eye;  but  when  the  glass  globe  .is  inverted  over  tku 
dissection,  we  shall  then  see  it,  floating  between  the  cho 
Toid  and  nervous  pulp  of  the  retina:  this  is  the  membrane; 
described  by  Dr.  Jacob,  of  Dublin.* 

Having  seen  this  membrane,  the  choroid  may  be  stripped 
farther  off,  and  then  the  termination  of  the  nervous  matter 
of  the  retina  will  be  seen,  marked  by  a  vessel,  running  about 
the  eighth  of  a.n  inch  from  the  margin  of  thelens.f  Some 
vessels  will  be  seen  unclor  the  nervous  matter  ;  they  are  on 
the  Tunica  Vcisculosa  Retince.  It  may  now  be  understood, 
that  the  nervous  pulp  of  the  retina,  is  contained  between 
the  membrane  of  Jacob  and  the  tunica  vasculosa. 

The  transparent  coats  which  contain  the  humours,  may 
now  be  examined. 

If  we  make  a  puncture  in  the  angle  between  the  margin 
of  the  lens  and  the  vitreous  humour,  and  then  blow  into  the 
puncture,  we  shall  distend  the  cavity  that  is  called  the  Pe- 
tition Canal,  and  which  surrounds  the  lens.  When  it  is 
distended  with  air,  or  size  injection,  it  has  a  plaited  appear- 
ance, whence  it  was  called  by  the  French  anatomists,  Canal 
Godronnee.  Different  modes  of  showing  this  part,  will  be 
described  presently.  On  the  plaits,  we  shall  see  black  stria?, 
which  have  erroneously  been  called  the  ciliary  processes  of 
the  retinfE  ;  they  are  nothing  more  than  marks  left  by  tho 
•iliary  processes  ; — this  appearance,  however,  gives  a  good 
idea  of  the  shape  and  situation  of  these  processes.  J 

If  we  make  a  puncture  on  the  anterior  part  of  the  lens, 
and  blow  into  it,  its  capsule  will  be  raised  ;  in  doing  this.  » 

*  This  membrane  was  shown  to  me  by  Dr.  Jacob,  while  I 
was  on  a  visit  to  Dublin,  in  1318. — Since  that  time,  I  b 
always  demonstrated  it  by  the  name  of  Tunica  Jacobi,  in 
honour  of  my  friend,  who  discovered  it. 

f  By  dropping  a  little  weak  acid  on  the  retina,  the  n- 
matter  will  become  more  distinct ;  but  if  we  wash  the  sur- 
face with  an  alkaline  solution,  the  nervous  matter  will  In* 
destroyed,  and  then  the  tunica  vasculosa  will  be  seen. 

|  By  Winslow,  these  marks  are  called  S-ulci  Ciliarrs  ;  by 
',  Corona  Ciliaris  ;  by  C.  Bell,  Halo 
A  a 


290 

small  quantity  of  fluid,  which  is  called  the  Liquor  Morgag- 
ni,  will  escape. 

By  pushing  the  blow-pipe  into  the  vitreous  humour,  we 
may  distend  the  tunica  hyaloidea,  or  capsule  of  the  vitreous 
humour ;  this  is  not  a  regular  sac,  similar  to  the  capsule  of 
the  lens,  hut  has  more  of  a  cellular  structure,  and  contains 
the  humour  in  the  cells.  This  capsule  is  supposed,  by  many, 
to  split  at  the  anterior  part ;  one  portion  is  said  to  go  anteri- 
or to  the  lens, — the  other,  posterior  to  it ;  and  that,  in  this 
manner,  the  Petitian  canal  is  formed.  Mr.  Charles  Bell. 
however,  has  said,  in  his  Description  of  the  Eye,  that  the 
canal  is  formed  by  the  splitting  of  the  tunica  vasculosa  reti- 
nsB  ;  and  this  he  deduces  from  the  examination  of  the  fretal 
eye,  for  in  it,  may  be  proved,  that  the  vessels  of  the  tunica 
vasculosa  retina?,  are  continued  on  the  back  part  of  the  cap- 
sule of  the  lens.  But  as  all  these  .membranes  are  exceed- 
ingly delicate  and  transparent,  in  the  adult, — the  manner  in 
which  they  are  connected  together,  will  always  continue  to 
be  a  matter  of  dispute. 

If  an  eye  be  now  so  cut,  as  to  allow  the  lens  and  vitreous 
humour  to  fall  out,  in  connexion  with  each  other,  we  may 
again  have  a  good  opportunity  of  showing  the  Petitian  canal : 
for  if  we  make  a  puncture  in  the  angle  between  the  two 
humours,  we  may  distend  the  canal  with  any  coloured  fluid, 
as  red  ink:  if  it  be  done  with  size  and  vermilion,  it  may  be 
kept  as  a  preparation.  The  easiest  way  of  doing  this,  is  to 
suck  up  a  little  of  the  fluid  with  a  glass  tube  which  has  been 
drawnto  a  point  sufficiently  fine  to  enter  the  puncture, — by 
blowing  a  very  little,  the  injection  will  fill  the  canal. 

This  part  may  also  be  easily  demonstrated  when  the  eye 
is  slightly  putrid,  by  cutting  of  the  cornea,  and  about  a  line 
of  the  sclerotic ; — we  should  then  tear  up  the  iris,  which 
will  separate  easily  from  the  ciliary  processes  ;  by  then 
pushing  the  processes  back  with  the  probe,  we  shall  be  ena- 
bled to  make  a  puncture  by  the  side  of  the  lens,  into  which 
the  blow-pipe  is  to  be  introduced ; — but  if  we  have  not 
made  the  puncture  in  the  right  place,  the  capsule  of  th*> 
tens,  or  the  capsule  of  the  vitreous  humour,  will  be  distended. 

There  is  still  another  transparent  membrane,  viz.  that  of 
the  aqueous  humour  :  in  some  animals,  as  in  the  hare,  and 
rabbit,  it  is  very  easy  to  demonstrate  it  ;  but  the  human  eye, 
and  that  of  the  sheep,  must  be  macerated,  almost  to  putre- 
faction, before  this  delicate  membrane  will  separate  from  th<* 
inside  of  the  cornea. 

We  have  now  to  examine  the  humours.     The  Aqur 
Humour  is  seen,  on  puncturing  the  cornea  :  it  is  Described 
as  having  two  chambers  ;  one,    anterior  to   the   iris. — tire 


291 

r,  posterior  to  it ;  but  when  we  cut  off  the  cornea,  we 
shall  see  that  the  lens  lies  almost  close  upon  the  iris, — so 
that  the  space  behind  the  iris,  (the  Posterior  Chamber,)  is  al- 
most ideal.* 

When  we  take  the  Lens  between  our  fingers,  we  shall 
find,  that  it  is  much  denser  in  its  centre,  than  in  its  circum- 
ference ; — if  we  boil  it,  or  put  it  into  acid,  we  shall  see  this, 
still  more  distinctly.  When  it  is  boiled,  it  will  have  a  la- 
minated form, — and  when  pressed  upon,  in  the  centre,  it 
will  generally  break  into  three  portions.  The  Vitreous  Hu- 
mour will  be  found  to  be  a  viscid  watery  humour,  contained 
in  a  transparent  cellular  membrane,  which  gives  it  the  ap- 
pearance of  solid  jelly.  If  we  put  this  humour  on  a  piece 
of  card,  and  then  make  two  or  three  holes  in  the  bottom  of 
the  card,  and,  through  them,  puncture  the  membrane,  the 
water  will  escape  :  then,  with  a  little  management,  we  may 
blow  into  the  capsule,  so  as  to  distend  arid  dry  it. — The 
parts  already  described,  are  the  principal  poins  of  the  anato- 
my to  be  attended  to  ;  but  if  we  can  procure  a  very  fresh 
human  eye, — by  making  a  simple  section  of  it,  at  half  an  inch 
posterior  to  the  cornea,  we  may  discover,  near  the  optic 
nerve,  on  the  temporal  side,  the  spot  described  by  Sommer- 
ing, — it  has  the  appearance  of  a  hole,  with  a  yellow  border 
surrounding  it.  But  I  believe  this  should  rather  be  consid- 
ered as  a  part  of  the  retina,  upon  which  the  nervous  matter 
is  deficient,  than  a  foramen.  If  we  take  the  posterior  half 
of  the  sclerotic,  and  look  upon  its  inner  surface,  we  shall  see 
the  entry  of  the  optic  nerve:  if  we  rub  the  nervous  matter 
off,  we  shall  see  a  black  hole,  this  is  called  the  porus  opti- 
cus, — however,  it  is  only  the  part  at  which  the  arteria  cen- 
tralis  retina?  enters.  By  squeezing  the  nerve  from  behind, 
we  shall  see  the  pulpy  matter  oozing  at  many  points, — prov- 
ing, that  the  nervous  matter  comes  through  several  forami- 
na, which  form  what  is  called  the  cribriform  part  of  the  scle- 
rotic, Lamina  Cribrosa. 

In  the  foetal  eye,  there  are  some  peculiarities,  which  i.- 
be  shown  by  injecting  a  fcetal  calf;  the  arteria  central^ 
tinte  will  be  seen  passing  through  the  centre  of  the  nerve, 
and  through  the  vitreous  humour,  to  the  back  part  of  the  cap- 
sule of  the  lens, — upon  which,  the  vessels  run  in  the  form  of 
a  spider's  web,  whence  the  capsule  is  sometimes  called  Tu- 
jiica  Aranea.     When  the  capsule  is  injected,  the  ve'ssels  of 
the  iris  will  also  be  filled.     Four  distinct  arteries  pass  to  the 

*  The  size  of  the  two  chambers  may  be  shown,  by  freez- 
ing the  eye,— a  thin  pellicle  only,  of  ice,  will  be  found  be- 
tween the  lens  and  the  iris. 


292 

iris;  from  the  branches  of  which,  vessels.may  be  seen  slioo;- 
ing  across  the  pupil,  in  that  membrane  which  is  most  per- 
feet  in  the  foetus  of  seven  months,  and  which  is  called  Mm 
brana  Pitpillaris. 


DISSECTION 

OF 

THE  MUSCLES 

AND 

LACHRYMAL  APPARATUS  OF  THE  EYE- 


THE  parts  external  to  the  ball  of  the  eye,  may  be  examin- 
ed on  the  body  in  which  the  muscles  of  the  face  have  been  dis- 
sected, 

By  cutting  off  the  orbicularis  muscle,  and  a  little  cellular 
membrane  which  is  under  it,  the  cartilages  of  the  eye-lids 
(Tarsi)  will  be  exposed.  .  In  doing  this,  we  must  not  lay  the 
upper  cartilage  quite  bare,  or  we  shall  be  in  danger  of  cut- 
ting the  tendon  of  the  muscle  which  raises  it, — Levator  Pal- 
pebrce.  By  pulling  the  eye-lids  towards  the  temple,  the  lig- 
ament which  connects  them  to  the  superior  maxillary  bone, 
will -be  seen.  In  dissecting  this  ligament,  we  must  keep 
close  upon  it,  or  we  shall  open  the  lachrymal  sac.  The  ex- 
ternal ligament  by  which  the  eye-lids  are  attached  to  the  t>s 
make,  may  be  shown,  by  pulling  the  lids  towards  the  nose^ 
The  names  of  External  and  Internal  Canthus  are  given  to 
these  angles  of  union. 

Between  the  union  of  the  eye-lids  on  the  nasal  side,  there 
is  a  little  projection  called  C'aruncula  Lachrymali*.  It  is  a 
prolongation  of  a  fold  of  this  kind,  which  forms  the  membra- 
na  nictitons  in  some  animals. 

The  eye-lids  are  lined  by  a  vascular  membrane,  which, 
when  the  eye-lids  are  everted,  will  be  seen  to  be  continued 
over  the  anterior  part  of  the  eye,  whence  it  is  named  Cojunc 
tiva,  or  Adnata. 

We  may  now  examine  the  apparatus  for  the  secretion  o£ 
the  tears,  and  for  their  passage  into  the  nose. 

If  we  pull  down  the  upper  eye-lid,  and  cut  the  cellular 


293 

connexion  between  it  and  the  frontal  bone,  we  shall  dis- 
cover the  lachrymal  gland.  It  will  be  found  very  difficult  to 
inject  the  ducts  by  which  the  tears  pass  from  this  gland  into 
the  space  between  the  eye-lids  ;  but  by  a  careful  examina- 
tion, we  may  find  eight  or  ten  which  open  upon  the  inntv 
surface  of  the  upper  eye-lid.  When  the  eye-lids  are  closed. 
a  little  gutter  is  formed,  which  conveys  the  tears  to  the 
Puncta,'  which  are  small  openings  in  each  eye-lid,  on  little 
eminences  at  the  nasal  extremities  of  the  cartilages.  It  is 
possible  to  pass  bristles  into  these  openings  ;  and,  by  a  little 
management,  they  may  be  so  directed  as  to  pass  into  the  sac 
which  lies  in  the  groove  in  the  os  unguis. 

If  this  groove  be  cut  upon,  the  Lachrymal  Sac  (in  which 
the  bristles  should  be  seen")  will  be  opened.  It  will  be  found 
lined  with  a  mucous  membrane,  and  so  large  that  it  will  ad- 
mit a  common  probe,  and  which,  when  slightly  curved,  may 
be  passed  from  the  sac  into  the  duct  which  carries  the  teai> 
into  the  nose. 

There  is  still  another  secreting  apparatus  upon  the  carti- 
lages :  it  is  composed  of  a  series  of  small  glands,  which  arc 
named,  in  compliment  to  the  anatomist  who  first  described 
them,  Jlfeibomcan.  When  the  eye-lids  are  everted,  the 
glands  will  be  seen  in  parallel  rows,  like  a  number  of  small 
ascarides,  on  the  surface  of  the  cartilages,  and  under  th»' 
conjunctiva.  Each  of  them  opens  on  the  margin  of  the  eye- 
lid by  a  separate  duct.  It  is  the  inflammation  of  one  of  thcsf 
small  glands  which  causes  the  common  disease  called  Stye. 

In  making  the  dissection  ofthe  eye-lids,  we  can  easily  un- 
derstand the  two  common  diseases,  ectropion  and  entropion. 
In  the  worst  case  of  ectropion,  it  is  necessary  to  cut  out  a 
portion,  and  unite  the  edges  ofthe  incision,  so  as  to  make 
the.  lid  shorter.  In  the  entropion,  an  operation  must  be  per- 
tonnedthat  will  make  the  lid  longer  ; — a  simple  snip  through 
the  lid,  which  will  be  filled  up  by  granulation,  will  sometimes 
be  sufficient  for  this.  The  necessity  of  great  care  in  remov- 
ing small  tumours  from  the  eye-lid,  must  be  evident,  when 
we  examine  the  cartilages.  I  have  seen  a  patient,  on  whom 
the  operation  of  ectropian  had  been  performed,  by  extracting 
the  cartilage  ;  the  consequence  was,  that  the  eye  was  near- 
ly destroyed  by  the  constant  pressure  ofthe  oibicularis  mus- 
t.*le. 

The  muscles  of  the  eye  should  now  be  dissected^.     Wt? 
should  cut  through  the  eye-lids  at  their  two  points  of  union, 
and  then  separate  the  lower  eye-lid  from  the  ball  ofthe  « 
by  dissecting  the  conjunctiva  from  its  union  to  the-ball ; — we 
may  then  cut  off  this  eye-lid.     We  should  separate  the 
per  eye-lid  in  the  same  manner;  but  we  must  not  e\ 
A  a '2  ' 


294 

away,  as  the  levator  palpcbrse  must  yet  be  dissected. 

It  is  difficult  to  disscet  all  the  muscles  without  cutting  par? 
of  the  frontal  and  malar  bones;  but  if  we  are  desirous  of  pre- 
serving the  scull,  we  must  do  as  well  as  We  can  in  the  nar- 
row space.  To  make  a  fine  display  of  the  muscles  (if  the 
scull  has  not  been  opened)  we  should  cut  through  the  as- 
cending orbital  process  of  the  os  malie,  to  the  depth  of  au 
inch,  in  a  line  with  the  floor  of  the  orbit,  and  then  cut  the  ex- 
ternal angular  process  of  the  frontal  bone,  commencing  ia 
the  superciliary  ridge,  and  carrying  the  cut  down  so  as  to 
meet  that  on  the  os  malse. 

If  the  scull-cap  has  been  removed,  the  dissection  may  be 
made  still  more  easy  by  cutting  away  the  roof  of  the  orbit : 
but  in  doing  this,  we  must  not  come  upon  the  foramen,— 
nor  nearer  to  the  internal  angular  process  than  the  supercil- 
iary hole  :  for  if  we  break  up  the  optic  foramen,  we  shall 
destroy  the  origin  V)f  the  muscles  ;  and  if  we  cut  down  the 
internal  angular  process,  we  shall  cut  through  the  pully  of 
the  trochlearis* 

The  first  muscle  to  be  dissected,  is  the  only  one  which 
does  not  arise  from  the  foramen  opticum, — the  Obliquus  In-- 
ferior,  or  Externus.  To  stretch  its  fibres,  we  should  puU 
the  ball  of  the  eye  towards  the  temple, — for  this  muscle  arises- 
from  the  bone,  above  the  inferior  orbital  foramen,  and  is  h> 
serted  into  the  outer  part  of  the  ball  of  the  eye. 

Before  dissecting  the  muscles  which  pass  from  the  fora- 
men opticum  to  the  ball  of  the  eye,  we  should  pull  down  the 
remaining  part  of  the  upper  eye-lid,  and  dissect  the  muscle 
which  lies  immediately  under  the  roof  of  the  orbit,  viz.  the 
Levator  Palpebrce.  Having  dissected  this,  the  eye-lid  and 
muscle  should  be  removed. 

The  whole  of  the  dissection  now  consists  in  removing  the 
loose  fat  which  is  between  the  ntuscles.  We  shall  find  the 
Superior  Oblique,  or  Troche! aris,  lying  upon  the  os  planum : 
its  tendon,  after  running  through  a  small  ligamentous  and 
cartilaginous  band  (which  is  attached  to  the  lower  part  of  the 
internal  angular  process,)  passes  backwards,  below  the  rec- 
tus  superior,  and  is  inserted  into  the  ball  of  the  eye,  about 
its  middle  and  upper  part. 

There  are  no  particular  directions  necessary  to  enable  tho 
student  to  dissect  the  four  recti  muscles  ;  for  they  run  direct 
irom  around  the  foramen  opticum,  to  the  ball  of  the  eye, — 
4  heir  combined  tendons  forming,  on  the  anterior  part  of  the 
ball,  an  expansion  of  tendinous  membrane,  which  is  describ- 
ed as  a  coat,  common  to  the  ball  of  the  eye  and  to  the  mus- 
des  ;  it  is  called  the  Tumca  Albuginea, 

The  muscles  of  the  eve  maveasilv  be  recollected,  for  there 


295 

nly  seven  in  all ;  of  which,  six  belong  to  the  ball  of  tii< 
eye,  and  one  belongs  to  the  upper  eye-lid.  The  muscle  of 
the  eye-lid  is  called  Levator  Palpebrce  Superiorly.  It  arises 
from  the.  upper  edge  of  the  foramen  opticum,  and  is  inserted 
into  the  cartilage  of  the  eye-lid.  The  six  muscles  are  divi- 
ded into  the  Four  Rectia.nd  the  Two  Oblique.  The  four  reo 
ti  are  distinguished  from  each  other  by  the  terms  Levator. 
Depressor,  Mductor  and  Adductor  :  while  the  two  oblique 
are  named, — the  "one,  External  or  Inferior ;  the  other,  Inter- 
nal .  or  Superior ;  or,  from  its  passing  through  the  pully, 
Trochleari*. 

All  the  four  recti  arise  from  around  the  foramen  opticum, 
and  are  inserted  into  the  sclerotic,  at  nearly  equal  distances 
from  the  cornea.  The  internal  oblique  also  arises  from  the 
edge  of  the  foramen  opticum; — its  course  and  its  insertion 
have  already  been  described. 

The  external  oblique  cannot  be  forgotten,  as  it  is  the  only 
muscle  which  arises  from  the  outer  edge  of  the  orbit. 

The  dissection  of  the  nerves  of  the  orbit  has  already  been 
described  at  page  269. 

The  dissection  of  the  arteries  maybe  made  at  the  same 
time  that  those  of  the  brain  are  examined  ;  and  as  the  dis- 
section consists  in  merely  following  them  from  trunk  to 
branch,  I  shall  give  only  a  Table  of  them  : — 

OPHTHALMICA  CEREBRALIS.  Passing  into  the  orbit,  by 
the  foramen  opticum,  gives  these  branches : — To  the 
dura  mater  and'sinus  ;  2.  lachrymalis,  which  goes  to  the 
gland,  after  giving  many  branches  to  the  periosteum, 
optic  nerve,  &c.  ;  3.  ciliares ;  three  or  four  arterie.s. 
dignified  with  the  distinction  of  inferiorcs,  anterior es, 
breves,  longiores  ;  4.  supra  orbitalis  ;  5.  centralis  retina* 
G.  aethmoidales  ;  7.  palpebrales  ;  8,  nasalis  ;  9.  fron-- 
talis. 

METHOD  OF  MAKING  CERTAIN  PREPARA- 
TIONS OF  THE  EYE. 

It  will  be  very  useful  to  preserve  some  human  eyes,  to 
show  the  relative  situation  of  the  parts  :  for  this  purpose: 
the  eyes  must  be  very  fresh. 

A  student  will  find  it  difficult  to  imitate  some  of  the  pre- 
parations which  are  preserved  in  anatomical  museums  :  but 
any  one  may  make  suck  dissections,  as  will  give  a  general 
idea  of  the  anatomy  of  the  parts,  and  be  of  use  in  planning 
operations  on  the  eye.  If  we  remove  all  the  muscles,  &r. 
from  the  eye-ball,  and  cut  off  about  one  third  of  the  cornea. 


296 

raid  then  insinuate  the  blade  of  the  scissars  between  the 
ary  ligament  and  the  sclerotic,  that  we  may  cut  oft*  about  a 
third  of  the  sclerotic,  the  c'horoid,  and  its  connexion  with  the 
iris,  will  be  shown :  this  forms  a  very  good  preparation. — • 
Another  eye  may  be  prepared,  so  far  in  the  same  manner  ; 
it  is  to  be  completed,  by  cutting  away  the  portion  of  the  cho- 
roid  corresponding  to  the  sclerotic,  so  as  to  expose  the  reti- 
na ;  but  in  attempting  to  do  this,  we  shall  often  be  foiled. 
A  third  preparation  may  be  made,  nearly  in  the  same  man- 
ner ;  but  in  it,  we  should  remove  the  retina. 

This  last  preparation  will  be  very  useful  ;  for  not  only  wiH 
one  half  of  the  cornea, — the  size  of  the  anterior  chamber, — 
fhe  ligament-urn  ciliare, — the  iris, — and  the  pupil  be  shown, 
but  also  the  situation  of  the  lens  and  ciliary  processes,  and  the 
vitreous  humour,  will  all  be  distinct]}7  seen.  As  soon  as  such 
a  dissection  is  made,  the  eye  should  be  put  into  proof  spirit. 
By  this,  however,  both  the  lens  and  the  capsule  of  the  vitre- 
ous humour,  will  be  made  opaque. 

The  view  of  the  parts  in  this  section,  will  prove,  that  oc* 
enlists  who  say  they  have  put  the  cataract  into  the  posterior 
chamber,  must  be  ignorant  of  anatomy.  The  proper  place 
tor  the  introduction  of  the  needle,  in  couching,  so  as  to  avoid 
the  ciliary  processes,  will  be  evident.  In  considering  tin/, 
subject  of  couching,  there  is  a  point  of  great  importance, 
which  maybe  understood  in  the  dissection  of  even  a  sheep's 
eye,  viz.  the  possibility  of  the  lens  and  vitreous  humour  be- 
ing both  turned  round  in  the  attempt  to  couch.  When  thi,< 
happens,  total  blindness  may  be  the  consequence,  as  the  ner- 
vous matter  of  the  retina  may  be  destroyed  by  the  displace- 
ment of  the  vitieous  humour. 


SURGICAL  DISSECTION, 


JYECK  dJVD  HEAD 


THERE  are  so  many  important  questions  connected  wiiis 
the  Surgical  Anatomy  of  the  neck  and  head,  that  it  would  be 
impossible  for  me  to  enter  fully  into  any  one  ;  all  that  the 


297 

limits  of  a  book  of  this  land  will  permit,  is,  to  make  such  re- 
marks,  as  will  rouee  the  student's  attention  to  the  importance 
of  the  subject. 

I  shall  suppose  that  the  student  has  made  himself  master 
of  all  the  muscles,  arteries,  nerves,  &c.  and  that  he  is  now 
about  to  make  a  dissection  of  the  neck,  as  a  part  upon  which 
he  may  be  called  on  to  operate,  or  to  give  an  opinion  as  to 
the- nature  and  connexions  of  a  tumour.  The  vessels  should 
not  be  injected.* 

Previous  to  beginning  the  dissection,  the  student  should 
mark  all  the  prominent  points  with  ink  ;  he  should  then  vary 
the  position  of  the  head  and  neck,  and  compare  the  chan<ni 
which  take  place  in  the  points  which  he  has  marked.  In  ex- 
amining- the  neck,  he  should  not  only  note  the  appearance, 
but  also  the  feel  of  the  parts.  It  is  a  good  exercise  to  exam- 
ine one's  own  neck  in  this  manner,  before  a  looking  glass. 

It  is  not  now  necessary  to  give  any  rules  for  the  dissection 
of  each  part.  As  soon  as  WQ  raise  the  skin,  we  shall  ob- 
serve that  there  is  no  fascia  under  it  as  in  the  limbs,  but  a 
thin  muscle  (the  platysma)  :  wre  shall  naturally  pause  and 
consider  whether  we  can  assign  any  reason  for  this  differ- 
ence. But  the  important  question  will  be,  of  what  conse- 
quence is  the  recollection  of  this  muscle  in  operations  on  the 
neck  ?  If  it  be  forgotten,  even  in  the  simple1  operation  of 
opening  the  external  jugular  vein,  the  surgeon  may  be  foil- 
ed ;  for  as  the  vein  is  under  the  muscle,  the  fibres  will  close, 
and  prevent  the  flow  of  blood,  if  the  incision  be  not  made  ob- 
liquely. Those  who  have  once  dissected  a  tumour  from  un- 
der this  muscle,  will  never  forget  the  strength  of  these  fibres 
in  the  living  body,  though  they  appear  so  trifling-  on  the 
dead  subject.  We  can  now  understand  why  tumours  of  the4 
neck,  when  they  are  enlarged,  are  pushed  inwards  ;  and  that 
they  may  be  larger  than  what  a  superficial  examination  would 
lead  us  to  suppose. 

If  the  body  be  thin  and  anasarcous,  instead  of  the  fibres  of 
the  platysma  being  distinct  and  connected,  they  will  appear 
scattered  ;  and  the  cellular  membrane  between  and  under 
them,  will  have  the  form  of  a  fascia.  It  is  this  appearance 
which  has  led  some  surgeons  to  attach  more  importance  to 
what  they  call  the  fascia  of  the  neck,  than  to  the  platysma. 
Yet  I  must  admit,  that  though  the  cellular  membrane  will 
not  resemble  fascia,  in  a  body  where  the  muscles,  &c.  are 

*•  Perhaps  it   may  be  advantageous  to  inject  the  Arteries 
with  a  strong  solution  of  glue,  coloured  with  vermilion  iu 
this  case,  but  a  very  small  quantity  should  be  thrown  k 
;he  injection  easily  passes  into  the  vein?* 


298 

plump, — still,  it  will  generally  be  so  thickened,  in  e- 
quence  of  the  pressure  of  a  tumour,  that  it  will,  in  certain  ca 
;ses,  be  almost  as  strong  as  a  distinct  fascia :  it  is  important 
to  recollect  this  in  performing  operations  on  tumours  of  the 
neck. 

The  branches  of  nerves  which  'are  seen  when  the  integu- 
ments only  are  taken  off,  are  not  of  much  importance  in  a 
surgical  view. 

The  dissection  of  the  skin  should  now  be  carried  up  to  a 
line  drawn  from  the  tube  of  the  ear  to -the  nose.  We  shall 
then  see  that  there  are  no  muscular  fibres  on  the  parotid,  but 
that  it  is  covered  by  a  dense  layer  of  fascia.  This  fascia  wilJ 
in  some  degree  account  for  the  violent  pain  which  attends 
cynanche  parotidea  ;  for  not  only  will  the  nerves  be  compres- 
sed by  the  fascia,  but  it  will  also  form  a  natural  obstacle  to 
the  free  exit  of  matter.  I  have  seen  a  patient  actually  deli- 
rious from  the  pain  he  suffered  from  inflammation  of  the  pa- 
rotid. Under  this  fascia,  several  branches  of  the  portio  du- 
ra will  be  seen  ;  these  muscles  must  not  be  forgotten  ;  bo- 
cause,  in  the  very  simple  operation  of  taking  out  a  small  tu- 
mour from  this  part  of  the  face,  we  may,  by  cutting  these 
nerves,  cause  a  degree  of  distortion  in  the  lips  of  the  patient. 
The  risk  of  producing  a  certain  degree  of  paralysis,  ought  to 
be  explained  to  the  patient  before  we  commence  any  opera- 
tion on  this  part. 

We  should  now  raise  the  platysma,  by  cutting  it  through 
in  the  middle,  and  then  dissecting  one  portion  towards  the 
clavicle,  and  the  other  to  the  base  ofthe  jaw.  We  shall  now 
have  exposed  the  sterno  cleido  mastoideus,  and  tjie  superfi- 
cial muscles  which  are  connected  with  the  larynx.  There  is 
much  to  study  in  this  view.  The  first  question  that  will 
strike  us,  is,  where  ought  the  operation  of  laryngotomy  to 
be  performed  ?  The  nature  of  the  case  will  have  much  influ- 
ence on  our  decision  :  but  looking  to  the  parts,  as  they  no\v 
appear,  we  should  decidedly  fix  upon  the  space  between  the 
ihyroid  and  cricoid  cartilages,  because  it  is  the  most  superfi' 
cial,  and  there  are  very  few  vessels  upon  it ; — but  we  ought 
to  know,  that  a  portion  of  the  thyroid  gland  very  often  cros- 
ses this  part,  to  pass  up  to  the  os  hyoides.  If  the  case  be, 
such  that  we  cannot  operate  at  this  point  (but  luckily,  this 
does  not  occur  once  in  ten  times,)  then  the  operation  must 
be  performed  lower  down.  This  will  be  very  difficult ;  for 
we  must  not  only  go  below  the  thyroid  gland,  but  to  a  great 
depth  between  the  muscles,  to  reach,  the  trachea.  Howe^ 
ver,  this  is  not  all  the  difficulty ;— if  we  put  our  finger  upon 
our  own  larynx,  and  then  breathe,  as  a  patient  does  who  is 
gj  we  shall  be  able  to  form  some  idea  ofthe  tension 


299 

f)f  the  muscles,  of  the.distended  state  of  the  small  veins,  and 
of  the  frequent  change  in  the  position  of  the  larynx.  We 
must  net,  at  the  same  time,  forget  that  the  patient  must  be 
sitting  almost  upright.  These  considerations  will  give  us 
some,  notion  of  the  difficulty  of  performing  the  operation  of 
tracheotomy. 

The  histories  of  the  operations  on  the  larynx  are  most  im- 
portant ;  because,  by  them  only,  can  we  judge  of  the  difficul- 
ties. Some  excellent  cases  and  remarks  will  be  found  in 
Mr.  Charles  Bell's  Surgical  Observations,  and  in  the  Medi- 
co Chirurgical  Transactions.  There  is  also  a  case  related 
by  Dr.  Johnson  in  the  Medico  Chirurgical  Journal,  which  is 
highly  descriptive  of  what  really  takes  place  during  the  op- 
eration of  laryngotomy.  This  case  is  also  remarkable,  as 
the  patient  was  still,  at  the  end  of  three  years,  obliged,  and 
able,  to  wear  a  tube  in  the  larynx. 

If  we  should  be  c-  lied  upon  to  perform  an  operation,  to 
relieve  a  child  which  has  sucked  a  pebble  or  pea  into  the 
larynx,— the  space  between  the  two  cartilages  will  proba- 
bly be  the  most  proper  part  in  which  to  open  the  larynx- 
I  have  dissected  a  child  whose  death  was  occasioned  by 
a  pebble  sticking-  exactly  opposite  to  this  part  : — had  assist- 
ance been  brought  sufficiently  early,  the  child  might  have 
been  saved  by  a  cut  with  the  lancet. 

The  success  attending  a  case  which  is  related  by  M.  Che- 
valier, would  induce  us  to  open  the  larynx  at  this  part, 
when  a  child  is  dying  of  croup. 

We  may  now  consider  the  Surgery  of  the  Arteries. 

We  now  know  that  if  we  were  to  turn  up  the  edge  of  tho 
sterno  cleido  mastoideus,  that  we  should  corne  upon  the 
sheath  of  the  carotid  artery;  but  before  we  expose  it,  wr 
should  think  of  all  the  diseases  and  accidents  to  which  the 
artery  is  liable. 

The  cases  already  recorded  of  aneurism  of  the  carotid  ar- 
tery, prove,  that  it  generally  takes  place  at  the  bifurcation. 
Seeing  the  proximity  of  this,  to  the  sensible  part  ofthr 
larynx,  we  can  understand  how  the  aneurismal  tumour  may 
be  pressed  in  upon  it,  by  the  platysma,  and  thus  produce  irri- 
table cough,  and  symptoms  referable  to  pressure  on  thf 
n  erves  of  the  larynx.  This  irritation  has  been  the  cause  of 
the  death  of  some  patients,  upon  whom,  even  the  operation 
of  tying  the  carotid  was  performed  ;  but  this  is  no  reason 
H  gainst  the  operation  ;  on  the  contrary,  it  is  a  motive  for 
its  early  performance,  and  before  the  tumour  is  much  enlarg- 
ed. 

Before  an  operation  is  decided   on,  we  should  carefully 
;ii  all  tho  circumstances  of  the  case.     It  is  important 


300 

•Me collect,  that  a  small  tumour  situated  over  the  an 
so  as  to  be  moved  at  each  pulsation,  has  heen  occasionally 
mistaken  for  aneurism.  I  have  not  only  heard  of  such  in- 
stances, but  I  have  even  been  consulted  in  a  case  of  enlarge- 
ment of  one  lobe  of  the  thyroid  gland,  for  which  the  patient 
was  sent  a  journey  of  forty  miles,  that  the  carotid  artery 
might  be  tied,  to  cure  the  supposed  aneurism. 

The  question  will  force  itself  upon  us,  where  is  the  arte- 
ry to  be  tied?  If  the  aneurismal  tumour  be  lower  down 
than  the  bifurcation  of  the  carotid,  then  it  will  be  very  diffi- 
cult to  decide,  and  probably  the  operation  will  be  unsuccess- 
ful, as  we  must  either  come  too  close  on  the  tumour,  or  too 
near  the  origin  of  the  carotid;  however,  if  we  may  judge 
from  the  cases  already  recorded,  the  tumour  will  generally 
be  formed  at  the  bifurcation, — and  when  it  is  so,  the  most 
advisable  point  to  tie  the  carotid,  will  be,  where  it  is  cros- 
sed by  the  omo  hyoideus.  (a) 

When  the  edge  of  the  sterno  cleido  mastoideus  is  raised 
in  a  strong  man,  neither  the  artery,  vein,  nerve,  nor  even 
the  sheath  of  the  vessols  will  be  se«n,  but  only  the  omo 
hyoideus,  covered  with  a  broad  and  smooth  membrane. 
If  we  mark  the  lower  edge  of  this  muscle,  and  cut  the  mem- 
branous expansion,  and  then  draw  the  muscle  towards  the 

(a)  Th©  muscles  at  the  side  of  the  neck,  after  the  platys- 
ma  myoides  has  been  dissected  off,  exhibit  several  triangu- 
lar figures,  in  which  the  corotid  and  subclavian  vessels  are* 
comprehended.  To  present  this  appearance,  let  the  head 
(the  subject  lying  on  its  back,)  be  turned  to  one  side,  in  a 
manner,  that  the  base  of  the  lower  jaw  and  clavicle  of  the 
other  side  may  lay  parallel  with  each  other.  The  -side  of 
the  neck  thus  adjusted,  will  present  a  paralellogram,  which 
the  sterno  cleido  mastoid  muscle  will  divide  into  two  trian- 
gles ;  and  those  are  further  subdivided  as  follows.  Is? 
Between  the  feet  of  the  sterno  cleido  mastoid  a  triangu- 
lar form  is  seen,  having  for  its  base  a  portion  of  the  clavicle, 
near  the  sternum  ;  in  this,  the  subclavian  artery  is  situated 
before,  it  has  passed  the  scaleni  muscles.  2d  Another 
space  will  be  found  bounded  in  front  by  the  trachea, 
above  by  the  anterior  belly  of  the  digastricus  muscle,  and 
toward  the  shoulder  by  the  inner  leg  of  the  sterno  cleido 
mastoid ;  in  this,  the  carotid  artery,  at  the  lower 
half  the  neck,  is  placed.  3d,  Another  is  bounded  by  the 
posterior  belly  of  the  digastricus  above ;  by  the  anterior 
•edge  of  the  upper  half  of  the  sterno  cleido  mastoid  muscle 
below;  and  by  the  anterior  belly  of  the  omo  hyoideus  on 
the  fore  part  ;  in  this  the  carotid  arter/  is  situated  at  the 


301 

fear,  we  shall  expose  the  sterno  thyroideus,  and  the  gene- 
ral sheath  of  the  vessels  and  nerve/'-"  If  we  open  the  sheath, 
by  scratching- upon  it  close  to  the  edo-e  of  the  sterno  tlr 
deus,  we  shall  then  open  only  that  division  of  it,  which  "con- 
tains the  artery  ;  so  that  neither  the  jugular  vein  nor  the 
par  vagum  will  be  exposed,  nor  will  the  recurrent  nerve  be 
endangered;  but  if  we  draw  the  omo  hyoideus  towards  th< 
Srachea,  then  we  shall  be  obliged  to  cut  upon  the  middle 
nf  the  sheath,  by  which  we  shall  come  on  the  groat  vein  and 
nerve,  and  perhaps  on  branches  of  the  superior  thyroid  arto- 
ly,  which  will  make  it  more  difficult  to  tie  the  carotid  neat- 
ly. It  will  now  be  evident,  that  the  great  vein  will  be 
endangered  if  the  ligature  be  introduced  between  the  vein 
and  artery.  It  need  hardly  be  mentioned,  that  the  sympa- 

upper  half  of  the  neck.  4th  There  is  another  triangular 
space,  in  the  centre  of  which  the  submaxillary  gland  is  sit- 
uated :  this  is  bounded  on  one  side,  by  the  base  of  the  lower 
jaw ;  and  on  the  other  two  sides  by  the  two  bellies  of  the 
digastricus  muscle.  5th.  The  scapular  three  fourths  of  the 
clavicle,  becomes  one  side  to  a  fifth  triangle  ;  while  the  outer 
belly  of  the  omo  hyoideus,  with  the  outer  edge  of  the  outer 
leg  of  the  sterno  cleido  mastoid,  afford  the  other  two  sides. 
In  this  triangular  space  the  subclavian  artery  is  to  be  found., 
after  it  has  passed  the  scaleni  muscles  in  its  way  to  the  axil- 
la. The  belly  of  the  omu  hyoideus  which  takes  a  part  in 
forming  this  triangle,  lies  nearly  parallel  with  the  clavicle  in 
the  natural  state  of  parts,  being  connected  with  it,  by  a  deep 
seated  fascia  of  the  neck  $  therefore  naturally,  this  muscle 
runs  in  a  curved  line  from  the  os  hyoides  to  the  shoulder ; 
when  it  is  freed  from  the  connexion  with  the  clavicle,  it  rises 
in  the  neck,  making  this  fifth,  almost  an  equilateral  trian- 
gle. In  the  operation  for  tying  the  artery  after  it  has  pas- 
sed the  scaleni,  it  is  the  duty  of  the  surgeon  carefully  t< 
make  the  separation  spoken  of,  iuthe  course  of  his  dissection  ; 
otherwise,  1  know  not,  how  he  will  be  led  to  the  proper  situ- 
ation of  the  artery.  Gth.  The  last  triangular  space  found 
on  the  side  of  the  neck,  completes  the  parallelogram.  It  i,-- 
bounded  by  the  outer  edge  of  the  sterno  cleido  mastoid  mus- 
•le,  for  two  thirds  its  length  from  above  ;  by  the  outer  belly 
of  the  omo  hyoideus  ;  and  by  the  edge  of  the  trapezias  mus- 
de,  extending  from  the  shoulder  to  the  tubercle  of  the  os  oc- 
oipitis. — In  this  triangle,  no  important  vessels  lie,  but  her<- 
.-3  found  that  chain  of  lymphatic  glands,  occupying  the  sid 
the  neck,  that  are  occasionally  affected  by  scrofula. 

*Some  branches  of  the  descendens  noni,  will  be  seen 
v>n  the  sheath  and  the  muscle. 
Bb 


302 

tlielic  nerve  lies  close  on  the  spine,  and  quite/ separated 
from  the  general  sheath  of  the  vessels. 

In  making  this  dissection,  we  must  not  forget  that  the 
head  is  lying  in  a  very  different  position  from  that  of  a  pa- 
tient on  whom  an  operation  is  to  be  performed.  As  the  pa- 
tient will  probably  be  sitting-,  with  his  head  reclining  on  a 
pillow,  we  ought  to  elevate  the  neck  of  the  subject  into  that 
position.-— The  manner  in  which  the  artery  is 'here  advised 
to  be  tied,  is  nearly  the  same  as  that  which  is  given,  in  the 
illustrations  of  the  Grand  Operations  of  Surgery,  by  Mr. 
Charles  Bell.  It  differs  considerably  from  the  manner  of 
operating  recommended  by  Mr.  Cooper,  and  by  several  other 
Surgeons.  But  before  such  a  serious  operation  is  perform- 
ed, I  would  recommend  the  operator  to  read  every  thing 
that  has  been  written  on  the  question,  and  to  compare  the 
several  modes  proposed.  Many  interesting  cases  will  be 
found  in  the  Medico- Chirurgical  Transactions,  related  by 
Mr.  Cooper,  Mr.  Dalrymple,  Mr.  Vincent,  and  Mr.  Coates": 
and  also  many  excellent  remarks  on  the  principle  of  the  op- 
eration, in  the  illustrations  of  Surgery,  by  Mr.  Bell. 

At  the  place  just  pointed  out,  the  artery  may  be  cut 
down  upon,  so  as  to  be  compressed  between  the  linger  and 
thumb,  or  tied,  when  a  very  severe  operation  is  to  be  per- 
formed below  the  angle  of  the  jaw. 

It  is  hardly  necessary  to  consider  how  the  carotid  should 
be  tied,  when  cut  by  the  suicide ;  for  when  it  is  opened  by 
a  large  incision,  the  patient  will  probably  be  dead  before  the 
surgeon  is  brought  to  him  ;  but  still,  such  a  question  rnay 
offer.  Mr.  John  Bell  tied  i!  one  case,  with  success ;  but  the 
circumstances  were  peculiar,  for  the  unfortunate  person  wa* 
so  cool,  and  so  determined  to  commit  suicide,  that  after 
having  read  the  description  of  the  artery,  in  Mr.  Bell's  Work 
on  Anatomy,  he  stood  before  a  mirror,  and  calculated  the 
situation  of  the  carotid  so  nicely,  as  to  pierce  it  with  a  pen-  ! 
jorife;  but  in  consequence  of  the  small  size  of  the  external 
orifice,  the  haemorrhage  was  not  very  great, — the  external 
.  wound  closed,  and  an  aneurism  formed,  lor  which,  Mr.  Bel] 
performed  the  common  operation.. 

The  necessity  of  making  ourselves  intimately  acquainted 
with  the  bearings  of  this  artery,  \vas  strongly  impressed  up- 
on-me,  Eome  years  ago,  by  a  surgeon  relating  a  case  to  me, 
where,  after  a  stab  in  the  neck,  there  was  repeated  ha?morr- 
hage  :  on  saying  to  him,  Why  did  you  not  tie  the  carotid  '•: 
with  a  most  significant  shake  of  his  head,  he  replied,  "  Catch 
me  at  the  carotid  !"  But  the  times  are  now  altered ;  for, 
that  it  is  not  now  considered  a  difficult  operation  to  tie  this' 
artery,  is  proved,  by  some,  surgeons  having  ^ven  trirr1 


303 

iinont  of  tying  it  for  head-ache,  and  fur  tumours,   Ov 
but  it  is  to  be  hoped,  that  even  the  great  ease  with  which  the 
artery  maybe  found,  will  not  induce  us  to  repeat  any  of 
fhose  experiments. 

We  may  now  prosecute  the  dissection  towards  the  an-. 
of  the  jaw,  and  consider  the  manner  of  securing  the  vessels, 
when  cut  at  the  root  of  the  tongue,  by  the  suicide. 

We  see  the  larnyx  and  the  sterno  cleido  mastoideus  pro- 
tect tho  carotid,  and  that  the  branches  most  exposed,  aiv 
those  of  the  lingual  and  facial  arteries.  The  cornu  of  the  OH 
hyoides  should  be  carefully  marked ;  for  this  is  the  part 
which  we  should  feel  for,  as  a  guide,  by  which  we  shall  ea- 
sily find. the  lingual  and  'facial  arteries.  The  vessels  will 
generally  be  easily  secured  in  the  wound  made  by  the  sui- 
cide ;  for,  there  will  be  a  large  open  incision,  and  before  we 
are  brought  to  him,  the  quantity  of  blood  lost,  will  have  di- 
minished the  arterial  force.  In  some  cases,  it  maybe  diffi- 
cult to  tie  the  arteries  neatly. — I  have  been  obliged,  in  sc- 
c  jndary  haemorrhage  under  the  tongue,  to  pass  a  needle  and 
'  uread  coarsely  round  a  bleeding  surface.  This  was  against 
ile;  but  I  was  forced  to  do  it, — because  the  state  ofth< 
parts  was  such,  tiiat  I  could  not  discover  the  bleeding  ves- 
sel,— and  as  the  source  of  the  hsemorrliage  was  exactly  in 
the  middle  of  the  throat,  I  was  afraid,  that  if  I  tied  one  caro- 
tid, I  should  be  obliged  to  tie  the  other  also;  and  that,  even 
if  J  tied  the  carotid  from  which  the  vessel  arose,  there 
would  still,  from  the  anastomosing  vessels,  be  bleeding  suf- 
ficient to  destroy  a  jmtient  who  had  already,  for  the  second 
time  in  six  days,,  lost  two  pounds  of  arterial  blood.  The  pa- 
tient did  well. 

We  have  now  brought  the  dissection  up  to  the  angle  of  the 
jaw  ;  and  here  comes  the  very   important  question  of  extir- 
,11  of  tumours. 

In  dissecting  up  the  platysma,  we  exposed  parts  of  the 
maxillary,  and  parotid  glands  ;  under  the  margin  of  the 
submaxillary,  and  sometimes  within  its  substance,  we  shall 
ihi'l  a  small  lymphatic  gland, — when  this  becomes  diseased, 
and  grows  large  and  hard,  it  presses  up  the  submaxillary 
gland,  so  as  to  give  it  the  appearance  of  being  affected  ;  and 
thus  we  have  narratives  of  the  extirpation  of  the  submaxil- 
lary, when,  most  probably,  the  disease  has  been  only  in  the 
lymphatic  gland  ;  for  the  salivary  glands  are  very  seldom 
scirrhous.  The  dissection  will  show,  that  an  encysted  tu- 
mour may  sometimes  betaken  out,  without  much  haemorr- 
hage.— In  such  a  case,  we  should  first  mark  the  situation  of 
1  he  facial  artery  and  vein,  and,  voiding  them,  make  an  inci- 
on  the  edge  of  the  submaxillary  gland,  so  that  we  m  >y 


.304 

lift  up  itsejge,  and  scoop  out  the  tumour ;  but  if  it  be  very 
hard,  and  adhering  to  the  gland,  then  we  may  have  con- 
siderable bleeding,  but  not  necessarily  dangerous ;  for  it 
will  probably  be  from  the  facial,  or  lingual  artery, — and 
either  of  these  arteries  may  be  tied,  the  cornu  of  the  os  hyoi- 
<les  being  the  principal  guide;  for  the  lingual  artery 'lie> 
above  it,  and  the  facial  a  little  higher.  We  must  not  for- 
get that  the  lingual  nerve  is  situated  between  these  vessels. 

These  remarks  upon  the  liability  of  a  scirrhous  lymphatic 
being  mistaken  for  disease  of  the  salivary  gland,  apply  more 
forcibly  to  the  tumours  which  are  connected  with  the  paro- 
tid. Every  student  who  examines  the  anatomy  of  the  paro- 
tid gland,  and,  particularly  when  it  is  injected  with  quick* 
silver,  will  suspect  that  the  histories  of  operations,  in  which 
a  diseased  parotid  is  said  to  have  been  wholly  extirpated, 
are  erroneous.  The  external  carotid  artery  passes  through 
the  substance  of  the  gland, — but  this  is  no  objection  to  the 
accuracy  of  the  report ;  for  it  maybe  tied  both  above  and 
below;  but,  is  there  no  danger  of  cutting  the  internal  caro- 
tid, or  the  internal  jugular,  or  the  par  vagum,  in  the  attempt 
to  extirp  ite  those  parts  of  the  gland  which  are  situated  so 
deep  as  the  space  between  the  occuput  and  atlas  ?  These 
considerations  induce  me  to  believe,  that  we  cannot  extir- 
pate the  parotid  gland. 

It  is  frequently  necessary  to  cut  off  a  portion  of  the  paro- 
tid, when  a  scirrhous  tumour  is  imbedded  in  it  :  in  these  op- 
erations, the  blood  issues  as  from  a  sponge,  so  that  it  is  very 
difficult  to  find  all  the  vessels  ;  but  in  the  greater  number  of 
cases,  the  graduated  compress  will  restrain  the  bleeding 
from  the  smaller  arteries.  If  We  must  tie  the  external  caro- 
tid previous  to  such  an  operation,  we  may  proceed  thus  : — 
If  we  cut  through  the  skin,  from  the  lobe  of  the  ear,  towards 
the  cornu  of  ihe  os  hyoides,  and  then  dissect  through  the 
platysma  myoides,  we  shall  come  upon  the  digastric  ;  and  if 
we  then  dissect  along  the  upper  edge  of  this  muscle,  we 
shall  expose  the  stylo  hyoideus, — by  forcing  this  last  muscle* 
downwards,  we  shall  find  the  continued  trunk  of  the  exter- 
nal carotid. 

In  extirpating  tumours  from  this  part,  we  must  cut  across 
many  branches  of  the  portio  dura,*  which  will  cause  partial 
paralysis  of  the  face. 

*  Since  the  use  of  the  portio  dura  has  been  illustrated  by 
the  facts  of  comparative  anatomy,  and  by  various  experi- 
ments instituted  by  Mr.  Bell,  we  have  been  able  to  explain 
many  symptoms  of  disease,  which  have  hitherto  puzzled  eur- 


305 

v 

The  dissection  of  the  duct  of  the  parotid  should  now  bo 
made,  and  its  situation  accurately  marked,  that  we  may  avoid 

That  I  may  direct  the  student's  attention  more  particular- 
ly to  this  subject,  I  shall  mention  one  or  two  cases,  which 
are  illustrative  of  the  consequence  of  an  injury  to  this  nerve. 
In  a  case  of  cynanche  parotidea,  where  suppuration  took 
place,  every  muscle  to  which  the  portio  dura  went,  was  pn  - 
ralyzed  in  the  act  of  respiration,  or  expression  ;  but  the  samr 
muscles  were  still  efficient  in  the  act  of  mastication  :  thus., 
when  the  patient  attempted  to  whistle,  or  when  he  was 
made  to  sneeze,  the  muscles  of  only  one  side  acted,  but 
when  he  chewed  his  food,  the  muscles  of  both  sides  were  in 
full  action.  This  paralysis  continued  for  a  considerable  timo 
after  the  sinuses  were  healed  ;  I  then  lost  sight  of  the  pa- 
tient. 

A  slight  degree  of  paralysis  of  one  side  of  the  face,  is  of- 
ten seen  in  young  people.  Such  cases  we  have  generally 
been  able  to  trace  to  an  inflamed  gland  below  the  ear.  J 
was  lately  consulted  in  a  very  interesting  ease,  nearly  of  a 
similar  nature.  A  young  lady  had,  for  several  years,  a  dis- 
tinct twist  of  one  side  of  her  mouth,  particularly  when  she 
smiled  ;  but  of  late,  she  has  had  an  affection  of  her  eye-lid. 
As  she  was  under  the  care  of  a  gentleman  who  was  acquaint- 
ed with  the  experiments  which  we  had  been  making  in 
Windmill-street,  the  cause  of  the  twist  of  the  mouth  was, 
by  hinvcorrectly  referred  to  a  severe  attack  of  inflammation, 
which  the  lady  had  had  some  years  ago  ;  but  as  he  found  it. 
difficult  to  understand  why  the  eye  should  be  also  now  affect- 
ed, he  begged  that  I  would  see  the  patient  with  him. 

On  noticing  the  action  of  the  muscles,  which  I  did  while 
the  lady  was  sitting  at  luncheon,  I  observed  that  no  act  inn 
was  deficient  while  she  was  eating,  but  that  there  was  a  dis- 
tinct paralysis  when  she  smiled  or  laughed  ;  however,  I  was 
a  little-  puzzled  to  see  the  muscles  of  the  mouth  so  distinctly 
affected,  and  not  those  of  the  eye  ;  because  I  had  found  iii 
all  the  experiments  in  which  the  portio  dura  was  cut,  and  in 
the  cases  where  the  paralysis  had  been  produced  by  an  in- 
flamed gland  under  the  ear,  that  both  the  muscles  of  the  eye 
and  of  the  mouth  were  affected  at  the  same  moment.  But 
on  farther  inquiry,  tho  cause  of  the  difference  in  this  casf.» 
was  explained  ;  for  I  found  that  the  inflammation  which  had 
been  the  original  source  of  the  injury  to  the  nerve,  was  con- 
lined  to  the  space  above  the  molar  teeth,  so  that  the  branch- 
.es  of  the  nerve  which  go  to  the  muscles  round  the  eye,  wero 
not  included  in  the  disease.  The  twitching  of  the  eye-lki 
was  quite  different  from  that  of  the  muscles  of  the  mouth — 


306 

it  during  the  operations  on  the  face.  We  shall  find  that  a 
line,  drawn  from  the  middle  of  the  tube  of  the  ear  to  the 
opening  of  the  nostril,  will  generally  be  immediately  oven 
the  duct ;  but  though  we  may  mark  its  situation  pretty  accu- 
rately, we  shall  proceed  with  less  dread  in  removing  a  tu- 
mour that  is  situated  near  it,  if,  instead  of  trusting  to  our 
recollection  of  the  situation  of  the  duct,  we  pass  a  fistula 
lachrymalis  probe,  into  it  : — this  may  be  easily  done  by 
averting  the  cheek  ;  for  the  opening  of  the  duct  will  be 
found  opposite  to  the  second  molaris. 

The  bleeding,  in  most  operations  on  the  face,  will  be  com- 
manded by  the  assistant  pressing  on  the  facial  artery,  where 

It  was  only  that  slight  spasmodic  affection  which  is  so  com- 
mon in  hysterical  girls,  and  would  not  have  been  noticed, 
had  it  not  been  supposed  to  have  some  connexion  with  the 
state  of  the  mouth.  This  young  lady  told  me,  that,  to  a  cer- 
tain degree,  she  could  command  the  action  of  the  muscles  ; 
but,  that  she  found  it  impossible  to  overcome  it  on  her  entry 
into  a  room  where  she  was  obliged  to  accost  strangers. 

There  are  certain  tumours  under  the  ear,  which  are  of  so 
<!angerous  a  nature,  that  it  is  necessary  to  remove  them 
without  taking  into  account  the  paralysis  consequent  upon 
cutting  the  branches  of  the  portio  dura  ;  still,  there  may  be 
cases  where  the  patient  will  not  thank  the  surgeon  for  rid- 
ding him  of  a  trifling  tumour,  at  the  expense  of  having,  ever 
after,  a  ludicrous  twist  of  the  face. 

Very  lately,  a  gentleman  wished  me  to  cut  out  a  small 
harmless  tumour,  which  was  situated  immediately  upon  the 
branch  of  the  nerve  which  goes  to  the  side  of  the  mouth. 
But  on  putting  the  question  to  him,  whether  he  would  run 
the  risk  of  having  the  side  of  his  mouth  paralyzed,  or  retain 
the  small  tumour,  which  might  almost  be  concealed  by  his 
whisker,  he  chose  to  submit  to  the  disfigurement  produced 
by  the  tumour,  as  probably  the  lesser  of  the  two. 

The  ridiculous  effect  which  is  produced  on  the  expression 
.of  a  monkey,  by  cutting  its  portio  dura,  would  almost  induce 
one  to  recommend  the  operation  to  some  of  our  comedians, 
particularly  after  the  extraordinary  success  of  one  actor, 
who,  from  the  peculiar  twist  of  his  mouth  and  eye,  appears 
to  have  a  paralysis  of  the  portia  dura  of  one  side. 

I  think  it  is  hardly  possible  for  surgeons,  now,  to  propose 
to  cut  the  branches  of  the  Vth  or  Vllth,  indiscriminately, 
for  the  disease  called  Tic  Douloureux.  There  is  reason  to 
believe  that  the  disease  is  seldom  or  ever  in  the  portio  dura, 
and  the  question  of  the  propriety  of  cutting  the  Vth  is  very 
doubtful. 


307 

it  passes  over  the  jaw.  After  the  removal  of  a  tumour,  the 
vessel  may  bo  secured  by  the  twisted  suture,  which  will,  at 
the  same  time,  hold  the'lips  of  the  wound  together.  In  this 
view,  we  shall  see  the  danger  of  opening  the  temporal  artery 
very  low  on  the  head. 

We  should  now  return  to  the  examination  of  the  lower 
part  of  the  neck. 

Before  we  divide  the  sterno  cleido  mastoideus,  we  should 
calculate  the  place  that  it  may  be  necessary  to  cut  this  mus- 
cle for  the  disease  of  wry  neck.  But  this  disease  is  general- 
ly either  in  the  sternal  or  clavicular  portion  only.  By  now 
laying  the  lower  half  of  this  muscle  on  the  chest,  and  by  de- 
taching the  sterno  hyoideus  and  thyroideus  muscles,  wo 
shall  expose  the  thyroid  gland.*  If  we  make  a  slight  cut 
into  the  gland,  we  shall  form  an  idea  of  its  vascularity,  and 
consequently  of  the  troublesome  haemorrhage  which  may  en- 
sue from  its  being  wounded.  I  have,  by  injecting  the  caro- 
tids of  a  suicide,  after  death,  proved  that  the  wounding  of 
the  gland,  even  without  opening  the  trunks  of  the  arteries 
which  pass  to  it,  is  sufficient  to  cause  a  fatal  haemorrhage. — 
This  should  make  us  suspect  that  there  may  be  some  danger 
in  passing  setons  through  the  gland,  especially  as  the  trunk 
of  the  carotid  has  been  found  in  it. 

When  the  four  arteries  of  the  thyroid  are  dissected,  and 
their  connections  with  the  sympathetic  and  par  vagum  are 
displayed,  we  shall  be  convinced,  that  the  surgeon  who  at- 
tempts to  extirpate  this  gland,  must  be  a  bold  one.  But  the 
greatest  objection  to  attempting  such  an  operation,  is,  that 
the  gland  is  seldom  in  such  a  state  as  to  require  removal, 
without  the  larynx  being  also  involved  in  the  disease. 

The  deep  dissection  may  be  continued  up  to  the  space  be- 
hind the  jaw,  and  then  we  shall  discover  a  portion  of  fascia 
which  runs  from  the  angle  of  the  jaw  towards  the  styloid 
process  and  the  os  hyoides.  This  may  encumber  us  much, 
in  extirpating  tumours  from  this  part.  We  should  now  par- 
ticularly mark  the  situation  and  appearance  of  the  stylo  hy- 
oideus muscle,  as  it  is  a  boundary, — beyond  which,  we 
should  carry  a  scalpel  with  great  hesitation.  When  we  ex- 

*  In  this  dissection,  the  anatomy  of  the  salivary  glands 
should  be  attended  to.  The  duct  of  the  submaxillary  gland 
of  each  side,  will  be  found  by  the  side  of  the  frenum  linguae. 
Those  of  the  sublingual  glands,  open  in  rows  on  eacli  side  of 
the  tongue.  The  situation  of  the  duct  of  the  parotid  has 
been  already  pointed  out.  Each  of  the  glands,  which  ar<? 
called  buccales^  labiales,  &c.  opens  by  distinct  ducts  on  the 
inside  of  the  cheeks  and  lips. 


308 

iirpate  tumours  that  are  under  this  muscle,  the  operation 
should  rather  be  by  scooping  and  tearing  with  the  handle  of 
the  knife,  than  by  cutting  with  a  sharp  blade. 

We  may  now  cut  across  the  masseter  muscle,  and  saw 
through  the  jaw,  near  the  mental  foramen,  and  remove  one 
side  of  it.  We  shall  then  see  the  nerve  enter  into  the  jaw  ; 
which  will  explain  the  reason  of  the  violent  pain  that  is  some- 
times felt  after  the  fracture  of  the  jaw,  or  where  we  attempt 
to  pull  away  a  piece  of  carious  bone.  We  shall  also  see  the 
artery  entering  into  the  foramen  ;  this  is  sometimes  torn  in 
pulling  the  last  tooth,  and  then  it  bleeds  violently.* 

After  the  mouth  has  been  thoroughly  cleansed,  the  raninal 
artery,  by  the  side  of  the  frenum,  may  be  exposed.  This  is 
the  vessel  which  has  been  cut  in  those  children  who  have 
died  of  bleeding-  in  consequence  of  dividing  the  frenum  liguse. 
We  are  sometimes  obliged,  even  against  our  judgment,  to 
perform  this  operation,  I  have  always  done  it  safely  while 
i  lie  child  was  crying  ;  for  then  the  mouth  is  wide  open,  and 
the  tongue  is  turned  up  :  it  is  only  necessary  to  make  such  a 
scratch  as  will  draw  blood, — for  that  will  satisfy  the  mother. 
By  the  side  of  the  frenum,  we  shall  find  the  duets  of  the 
submaxillary  gland  :  to  these  we  should  look  when  there  is 
a  swelling-  of  the  gland  ;  for  they  are  sometimes  obstructed 
by  a  small  calcules. 

"  If  we  could  trace  the  lymphatics  which  pass  from  the 
parts  within  the  mouth,  We  might  be  able  to  detect  the 
source  of  many  of  the  swellings  in  the  neck,  as  easily  as  we 
tio  those  of  a  bubo  in  the  groin  :  in  the  one  case,  a  sore  *on 
f  lie  penis  is  generally  the  cause  of  the  tumour, — and  in  the 
other,  an  ulcer  on  the  gum,  or  a  spoiled  tooth. 

We  should  now  examine  the  natural  state  of  the  tonsil. — 
We  shall  very  often  find  that  this  appearance  resembles  ul- 
oeration.  It  is  highly  important  to  recollect,  that,  in  con- 
sequence of  a  little  irritation,  such  as  that  produced  by  tak- 
ing mercury,  the  ducts  of  this  salivary  gland  will  have  so 
much  resemblance  to  an  ulcerated  surface,  that  they  may 
bo  mistaken  for  venereal  ulcers.  I  have  known  several  pa- 

*  We  have  been  told,  on  good  authority,  that  patients  have 
even  died  in  consequence  of  this.  An  anecdote  was  related 
to  me  by  an  Irish  surgeon,  wiiich  may  afford  a  useful  hint  : 
During  the  time  that  several  surgeons  were  consulting  on 
<he  propriety  of  tying  the  carotid  !  for  haemorrhage  from  this 
artery,  one  of  the  students  asked  the  patient  for  the  tooth 
which  had  been  extracted  ;  he  then  very  cooly  pushed  it  into 
place  again;  and  there  was  no  more  hemorrhage. 


309 

lients  put  upon  a  second,  and  severer  course  of  mercury,  ir 
oonsequence  of  the  surgeon  not  having  been  aware  of  this 
fact. 

As  we  may  sometimes  be  called  upon  to  scarify  the  en 
larged  tonsil,  we  should  recollect  that  a  small  artery  passes 
into  it  :  the  wounding  of  this,  however,  would  perhaps  do 
good  ;  but  such  a  case  has  happened,  as  the  wounding  of  the 
internal  carotid,  in  this  operation. — The  artery  will  be  found 
very  close  to  the  gland. 

We  should  now  examine  the  pharynx  and  larynx. 

Before  making  a  lateral  view  of  the  pharynx,  we  should 
introduce  a  probang  in  to  the  (Esophagus.  In  doing  this,  we 
shall  see  how  much  danger  there  will  be  of  passing  it  into 
the  larynx,  if,  in  the  introduction  of  it,  we  pull  out  the 
tongue. 

We  should  now  cut  through  one  side  of  the  pharynx.  An 
accurate  knowledge  of  the  natural  form  of  the  pharynx,  and 
of  the  beginning  of  the  oesophagus,  is  even  more  important  to 
the  surgeon,  than  a  knowledge  of  the  anatomy  of  the  ure- 
thra; because,  persons  of  a  particular  constitution  have  ve- 
ry frequently  symptoms  which  might  lead  a  surgeon  to  sus- 
pect that  they  arose  from  a  stricture  in  the  oesophagus. 

If,  with  this  suspicion,  a  surgeon  who  has  not  an  accurate 
knowledge  of  the  structure  of  the  part,  introduces  a  bougie, 
he  will  probably  be  led  into  tfye  idea  that  there  is  stricture, 
by  the  very  sudden  narrowing  of  the  tube  opposite  to  the  cri- 
coid  cartilage,  ami  particularly  if  there  should  be  at  the  same 
time  a  spasmodic  affection  of  the  parts,  which  is  very  com- 
mon, in  consequence  of  an  attempt  to  pass  a  bougie. 

If  he  now  perseveres  in  the  use  of  instruments,  to  cure  the 
supposed  stricture,  he  may  produce  such  a  state  of  the  parts 
as  will  most  certainly  be  followed  by  a  stricture,  which  is  ge- 
nerally the  cause  of  a  horrible  arid  lingering  death.  This 
subject  should  be  studied  by  reading  all  the  best  authors  who 
have  written  on  it. 

The  question  of  cesophagotcmy  may  now  be  considered. 
The  appearance  of  the  natural  parts  will  prove,  that  this  is 
one  of  those  operations  in  which  there  will  be  more  difficul- 
ty in  deciding  upon  the  propriety,  than  on  the  manner  of  per- 
forming it. 

I  have  once  assisted  in  opening  the  oesophagus,  to  relievo 
a  stricture  by  which  the  patient  would  have  been  destroyed 
in  two  or  three  days :  though  the  case  terminated  fatally,  I 
saw  no  reason  for  being  afraid  to  repeat  the  operation,  should 
a  patient  offer,  whose  stricture  has  become  so  narrow  as  to 
make  death,  from  starvation,  inevitable. 

If  we  make  a  section  of  the  scull,  such  as  is  described  at 


310 

:>:;^e  278,  we  may  understand  how  a  tube  may  be  p;> 
from  the  nose  into  the  larynx;  how  a  polypus  hanging-  down 
from  the  posterior  nostril,  may  produce  suffocation ;  how  il 
may  be  possible  to  restrain  a  violent  haemorrhage  from  the 
nose,  by  plugging  up  the  posterior  nostrils. 

We  may  now  understand  how  much  the  ethmoid  bone. 
;.? nd  even  the  brain,  may  be  endangered  by  the  forcible  ex-- 
traction of  the  polypi.  The  principles  upon  which  the  dif- 
ferent operations  of  fistula  lachrymalrs  are  to  be  performed, 
may  be  seen.  We  shall  also  be  able  to  determine  upon  the 
most  favorable  position  of  tho  head,  in  cases  where  there  is 
a  collection  of  matter  in  the  antrum ;  and  by  pulling  the  se- 
cond molaris,  we  shall  see  that  a  free  exit  might  be  given  to 
matter  collected  in  that  cavity. 

We  may  perform  the  operation  of  trephine  upon  the  sub- 
ject, with  much  advantage;  for  we  may  make  examples  of 
the  various  fractures  which  require  operation,  and  at  the 
.same  time  see  the  greater  number  of  difficulties  which  may 
occur  daring  the  operation  on  a  patient. 

If  we  allow  the  head  to  fall  on  the  ground,  we  shall 
probably  produce  simple  fracture^  with  extensive  fissure ; 
if  we  strike  it  a  smart  blow  with  a  hammer,  we  shall  per- 
haps produce  a  stellated  fracture  ;  in  such  a  case  as  this,  wo 
may,  with  small  levers  and  forceps,  pick  away  the  piece's  of 
bone,  without  using  the  trephine.  When  the  scull  is  struck 
with  a  sharp  point,  though  there  will  be  only  a  depression  or 
hole  in  the  external  tables,  yet  there  will  probably  be  an  ex- 
tensive fracture  of  the  tabula  vitrea ;  this,  it  is  evident,  will 
require  a  large  trephine.  If  the  head  be  allowed  to  fall  on 
the  vertex, — or  if  it  be  struck  with  a  heavy  body,  as  when  a 
brick-tfat  falls  from  a  building  on  the  top  of  the  head, — we 
may  find  that  the  fracture  has  taken  place  at  one,  or  both,  of 
the  temples. 

In  performing  the  operation,  we  should  pay  particular  a-t- 
fention  to  the  various  degrees  of  thickness  in  the  different 
parts  of  the  scull.  In  a  rickety  person,  we  may  expect  that, 
at  certain  points,  the  scull  will  be  very  thick.  As  we  shall 
.  find  that,  in  the  greater  number  of  sculls,  there  are  no  marks 
by  which  we  *can  be  guided  in  judging  of  the  thickness, — we 
shall  be  satisfied  of  the  justness  of  the  rule,  that,  the  opera- 
tion of  trephine  should  always  be  very  cautiously  performed. 

There  are  certain  points,  which  a  dissector,  who  had  not. 
seen  much  practice  in  surgery,  would  be  afraid  to  set  his  tre- 
phine upon, — as,  for  example,  in  the  course  of  the  longitudi- 
nal sinus;  but  experience  shows,  that  there  is  no  danger  in 
opening  the  scull  here.  The  manner  in  which  the  meningea 
media  frequently  runs  in  the  substance  of  the  bone,  will 


311 

•  to  us,  that  in  the  greater  number  of  cases  wheiv 
trephine  is  applied  over  its  course,  it  must  be  cut ;  but  this 
frhould  not  alarm  us, — for  when  the  artery  is  cut,  the  bleed- 
ing- can  be  easily  stopped. 

The  practical  surgeon  will  agree  with  the  dissector,  in 
Considering  it  very  difficult  to  apply  the  trephine  over  the 
irontal  sinuses,  or  in  the  line  of  the  spine  of  the  os  frontis. — 
When  the  external  table  of  the  frontal  sinus  is  removed,  wo 
can  understand  how  the  membrane  lining  it,  has,  in  ecme  op- 
erations, been  mistaken  for  the  dura  mater. 

By  striking  the  scull  smartly  with  a  mallet,  the  dura  ma- 
ter will  be  detached  from  the  bone,  at  the  part  struck  :  if  UK* 
head  be  afterwards  injected  with  size,  a  coagulum  will  be 
found  at  this  part.  This  experiment  would  lead  us  to  d< 
the  accuracy  of  Mr.  Abernethy's  explanation  of  the  cau.-e  of 
effusion  of  blood  between  the  dura  mater  and  the  bone. 

While  the  student  has  these  parts  before  him,  he  should 
read  the  Works   of  Pott,  John  Bell,  and  Abernethy,  and  oi" 
Charles  Bell ;  in  the  Fourth  Number  of  the  Surgical  Obser- 
vations, by  Charles  Bell,  he  will  find  many  remarks  applies 
ble  to  the  question  of  the  varieties  of  fracture. 


DISSECTION 

OF 

THE  ARM, 

AFTER  IT  IS  SEPARATED  FROM  THE  BOD\ 


THE  dissection  of  the  muscles  by  which  the  arm  is  attach  • 
"d  to  the  body,  is  described  at  pages  199  and  2^9. 

The  first  muscles  to  be  dissected,  are  those  surrounding 
the  shoulder  joint.*  A  block  should  be  put  under  the  joint, 
«o  as  to  make  the  fibres  of  the  principal  muscle,  the  Deltoid, 
tense.  We  shall  find  that  the  cellular  membrane  and  fal 
pass  to  such  a  depth  between  the  fibres  of  this  muscle,  that 

*  In  the  first  dissection,  every  thing  is  to  be  cur.  a^\ 
oopt  the  muscles. 


312 

?ho  knife  must  be  set  on  very  boldly,  before  we  can  make  it 
appear  clean.  After  the  origins  and  insertion  ofthe  muscle 
have  been  shown,  the  tendinous  fascia  by  which  it  is  con- 
nected to  the  base  of  the  scapula,  is  to  be  dissected  up,  so  as 
to  expose  the  muscles  wThich  are  below  the  spine  of  the  scapu- 
la. This  -mass  appears  at  first  to  be  formed  by  one  muscle 
only  ;  but  by  looking  near  to  the  lower  costa  ofthe  scapula, 
a  line  of  division  will  be  seen  in  it,  which  separates  the  Teres 
Minor  from  the  Infra  Spinatus  ^ — both  of  which  may  be  traced 
to  the  great  tubercle  on  the  head  ofthe  humerus.  On  the 
lower  edge  of  the  teres  minor,  a  distinct  and  large  muscle, 
viz.  the  Teres  Major,  will  be  seen  running  from  the  inferior 
angle  of  the  scapula  to  the  humerus,  to  be  inserted  along  with 
the  latissimus  dorsi. 

The  origins  of  the  deltoid,  from  the  clavicle,  acromion, 
and  spine  of  the  scapula,  must  now  be  raised.  A  small  part 
ofthe  muscle  may  be  left  attached  to  the  humerus.  A  set 
of  fibres  will  now  be  seen,  occupying  the  space  which  in 
above  the  spine  of  the  scapula,*  and  which  pass  under  the 
acromidn,  to  the  great  tubercle  on  the  head  of  the  humerus  ; 
these  form  the  Supra  Spinatus  muscle.  At  the  edge  of  the 
notch,  we  may  observe  the  origin  of  the  small  muscle  which 
passes  to  the  neck,  viz.  the  omo  hyoideus. 

We  may  now  turn  to  the  lower  surface  ofthe  scapula.— 
The  loose  portion,  which  will  probably  appear  ragged  and 
slightly  putrid,  is  a.  part  of  the  serratus  major  anticus  :  when 
this,  with  the  cellular  membrane  which  is  below  it,  is  dissect- 
ed off  towards  the  base  ofthe  scapula,  the  Subscapularis  will 
be  exposed.  This  muscle  will  be  found  to  occupy  all  the 
concave  surface  of  the  scapula,  and  to  be  inserted  into  the 
lesser  tubercle  ofthe  humerus. 

We  may  now  pass  to  the  dissection  of  the  muscles  which 
lie  on  the  hurnerus.  The  first  muscle  to  be  dissected  on  the 
forepart,  is  the  Coraco  Brarkialis ;  the  fibres  of  which  run 
in  a  straight  line  from  the  coracoid  process  to  the  inside 
of  the  humerus.  In  expos  ng  the  fibres  of  this  muscle,  those 
ofthe  short  head  of  biceps  will  also  be  shown.  The  belly  of 
the  Biceps  is  covered  by  a  thin  fascia,  which  is  to  be  raised, 
by  cutting  in  the  direction  ofthe  fibres. — When  near  the 
bend  ofthe  arm,  we  must  be  careful  not  to  cut  through  the 
band  of  fascia  which  passes  off  from  the  edge  ofthe  biceps  ; 
for  this  is  an  attachment  which  the  muscle  has  with  the  fas- 
cia that  covers  those  of  the  fore  arm.  The  insertion  ofthe 
biceps  into  the  tubercle  of  the  radius,  cannot  be  shown  until 

*  Perhaps  a  part  of  the  trapezius  may  still  be  attached  to 
the  clavicle  and  spine  ofthe  scapula :— this  should  be  rem<>v 


313 

!he  muscles  of  the  fore  arm  are  dissected;  nor  should  \Vf: 
•at  present,  cut  the  capsular  ligament  of  the  shoulder  joint-. 
~to  expose  the  origin  of  the  long  head  of  the  biceps  from  the 
glenoid  cavity. 

The  Brachinlis  Intcmus  may  be  seen  under  the  biceps.  As 
the  fibres  of  this  muscle  run  nearly  parallel  to  the  bone,  there 
can  be  no  difficulty  in  showing  them  in  their  whole  extent, 
iYom  their  origin  on  the  humerus  to  their  insertion  into  the 
•coronoid  process  of  the  ulna. 

The  large  mass  of  muscle  which  is  on  the  back  part  of  the 
arm,  forms  the  Triceps  Extensor  :  it  is  merely  necessary  to 
look  to  the  direction  of  the  fibres  of  the  three  different 
heads,  to  enable  us  to  dissect  them  down  to  their  union  and 
insertion  into  the  olecranon  ;  but  in  dissecting  the  lower 
part  of  this  muscle,  we  must  not  confound  it  with  the  Anco* 
#£Mtf,  which  passes  from  the  external  condyle  to  the  ulna. 

Before  dissecting  the  muscles  of  the  fore  arm,  the  fascia 
which  binds  them  together  should  be  exposed  :  this  is  most 
easily  done,  by  commencing  the  dissection  at  the  outer  part 
of  the  arm,  and  carrying  it  towards  the  inner.  The  dissec- 
tion should  be  continued  to  the  wrist ;  and  then  the  several 
muscles  which  compose  the  first  layer  may  be  seen  through 
the  transparent  fascia.  The  only  rule  necessary  to  be  re- 
collected in  the  dissection  of  these  muscles,  is  to  remove  the 
cellular  membrane  in  the  direction  of  the  fibres.  For  their 
arrangement,  and  their  origins  and  insertions,  see  page  317. 

The  muscles  of  the  hand  are  rather  difficult  to  dissect,  in 
consequence  of  their  connexion  with  the  palmar  aponeuro- 
ais.  This  fascia  ougnt  to  be  exposed  before  we  begin  to  dis- 
sect the  muscles.  The  incision  should  be  made  in  the  mid- 
dle of  the  hand,  from  the  annular  ligament  to  the  middle 
finger.  The  skin  is  to  be  carried  towards  the  thumb,  and 
towards  the  ulnar  side  of  the  hand.  But  in  cutting  in  the 
last  direction,  we  must  take  care  that  we  do  not  dissect  off 
the  little  muscle,  Palmar^  Brevis,  which  is  attached  to  the 
dkin  for  about  an  inch  below  the  pisiform  bone  :  indeed,  this 
muscle  should  be  exposed  before  the  fascia  is  dissected. 

CLASSIFICATION  OF  THE  MUSCLES  OF  THE 
ARM. 

It  is  hardly  possible  to  arrange  the  muscles  moving1  tlu? 
.humerus,  into  classes  which  shall  have  each  a  distinct  action 
to  perform, — in  consequence  of  the  motions  of  the  humeru?. 
on  the  scapula,  being  so  varied.  Perhaps  the  following  enu- 
meration will  assist  the  student  in  recollecting  them : — 

The  muscles  which  are  inserted  into  the  upper  part.  mu>* 
€c 


314 

raise  the  arm  :  thus  the  supra  spinatus,  infra  spinafats,  and 
leres  minor,  being  inserted  into  the  great  tubercle,  are  of 
this  class  :  so  is  the  delioides,  which  is  also  inserted  into  the 
upper  part  of  the  arm,  but  further  from  the  head. 

There  is  only  one  muscle  inserted  into  the  lesser  tubercle, 
the  subscapularis,  and  which  must  pull  the  s^rm  backwards 
and  downwards. 

Two  muscles  are  inserted  into  the  outer  edge  of  the  bicip- 
ital  groove, — the  pectoralis  major  and  coraco  brachialis  ;  and 
these  must  pull  the  arm  inwards  and  forwards. 

The  two  muscles  which  are  inserted  into  the  outer  part  of 
the  bicipita]  groove,  will  pull  the  arm  backwards,  viz.  the  la- 
Ussimus  dorsi  and  leres  major. 

TABLE  OF  THE  ORIGINS  AND  INSERTIONS  OF 
THE  MUSCLES  MOVING  THE  IIUMERUS.* 

MUSCLES    OF    THE    SHOULDER    LYING    ON    THE    SCAPULA. 

SUBSCAPULARIS.  OK.  1.  All  the  base  and  hollow  of  the 
scapula  internally.  2.  Its  superior  arid  inferior  costae. 

IN.  The  upper  part  of  the  internal  or  lesser  protuberance 
on  the  head  of  the  humerus. 

SUPRA  SPINATUS.  OR.  1.  From  all  that  part  of  the  base 
of  the  scapula  which  is  above  its  spine.  2.  From  the  spine 
and  superior  costa.  3.  From  the  fascia  of  the  scapula. 

IN.  The  part  of  the  larger  protuberance  on  the  head  of 
the  os  humeri  that  is  next  the  groove. 

INFRA  SPINATUS.  OR.  1.  All  that  part  of  the  base  of  the 
scapula  which  is  between  its  spine  and  inferior  angle.  2. 
The  spine,  as  far  as  the  cervix  of  the  scapula.  3.  The  fas- 
cia of  the  scapula. 

IN.  The  upper  and  middle  part  of  the  large  protuberance 
on  the  head  of  theos  humeri. 

TERES  MINOR.  OR.  From  the  inferior  costa  of  the  sca- 
pula, extending  from  the  neck  to  an  inch  and  a  half  from  the 
inferior  angle. 

IN.  The  back  part  of  the  large  protuberances  on  the  head 
6f  the  os  humeri. 

TERES  MAJOR.  OR.  1.  The  inferior  angle.  2.  Inferior 
costa  of  the  scapula. 


*  The  origins  and  insertions  of  the  latissinnis  dor>i  and 
pectoralis,  are  described  at  pages  229  and  109* 


315 

IN.  The  rulgc  at  the  inner  side  of  the  groove  for  umy  im- 
f|te  tendon  of  the  long  head  of  the  biceps  (along  with  the 
fS&don  of  the  latissimus  dorsi.) 

DELTOIDES.  OR.  From  the  outer  part  of  the  clavicle.  2. 
From  the  acromion.  3.  From  the  lower  margin  of  almost, 
the  whole  spine  of  the  scapula  opposite  to'the  insertion  of 
the  cucullaris  muscle. 

IN.  A  rough  protuberance  in  the  outer  side  of  the  os  hu- 
ihen,  near  its  middle. 

USE.  Its  centre  raises  the  humerus,  the  lateral  portions 
sustain  the  shoulder  joint. 

CORACO  BRACHIALIS.  OR.  The  coracoid  process  of  the 
scapula,  adhering  in  its  descent  to  the  short  head  of  the  bi- 
ceps. 

^  IN.  The  middle  of  the  internal  part  of  the  os  humeri,  near 
nie  origin  of  the  third  head  of  the  triceps. 

USE.  To  raise  the  arm  upwards  and  forwards. 


The  muscles  which  move  the  fore  arm  are  exceedingly 
smple  ;  as  the  form  of  the  joint  between  the  humerus  an*d 
bones  of  the  arm,  is  such  as  to  admit  only  of  two  motions, 
viz.  flexion  and  extension.  The  flexer  muscles  are  two, — 
tticeps  and  Brachudis  Internus ;  the  extensors  are  also  two, — 
?'riceps  and  Jlnconcus. 

TABLE   OF  THE  MUSCLES  WHICH  MOVE  THE 
FORE  ARM  ON  THE  HUMERUS. 

FLEXORS. — BICEPS  FLEXOR  CUBITT.  OR.  By  two  heads.- 
I .  Tendinous,  from  the  upper  edge  of  the  glenoid  cavity  of 
the  scapula.  This  tendon  passes  over  the  head  of  the  os  hu- 
mcri  within  the  capsule,  and,  in  its  descent  without  the  joint, 
runs  in  a  groove  on  the  head  of  the  6s  humeri.  and  covered 
by  a  membraneous  ligament  that  proceeds  "from  the  capsule 
and  adjacent  tendons.  2.  The  second,  and  shorter  head, 
arises  from  the  coracoid  process  of  the  scapula,  in  common 
with  the  coraco  brachialis  muscle. 

IN.  1.  By  a  strong  round  tendon,  into  the  tubercle  near 
the  upper  end  of  the  radius  ;  2.  and,  by  a  lateral  slip  of  fas- 
cia, into  the  sheath  of  the  fore  arm. 

BRACHIALIS  INTERNUS.  OR.  The  middle  of  the  os  hu- 
meri,  at  each  side  of  the  insertion  of  the  deltoid  muscle,  cov- 
ering all  the  inferior  and  fore  part  of  this  bone  ;  adheres  te 
the  ligament  of  the  joint. 

IN.  The  coronoid  process  of  the  ulna. 


316 

EXTENSORS. — -TRICEPS  EXTENSOR  CUBITI.  On.  By  three 
heads ;  the  first  and  longest,  from  the  inferior  costa  of  the 
scapula,  near  its  cervix.  The  second  head,  from  the  back 
part  of  the  os  humeri,  under  the  great  tubercle.  The  third* 
arises  by  an  acute  beginning  from  the  back  and  inner  part  of 
the  humerus,  and  continues  its  origin  all  down  the  bone. — 
These  three  heads  unite  lower  than  the  insertion  of  the 
teres  major,*  and  cover  the  whole  posteriar  part  of  the  hume- 
rus ;  from  which  they  receive  additional  origins  in  their  de- 
scent. 

IN.  The  olecranon,  and  partly  into  the  condyles  of  the  os 
humeri,  adhering  to  the  ligament. 

ANCONEUS.     OR.  From  the  back  part  of  the  external  con- 
dyle  of  the  os  humeri ;  it  soon  grows  fleshy. 
•  IN.  A  ridge  on  the  outer  and  posterior  edge  of  the  ulma.. 
being  continued  some  way  below  the  olecranon.     It  is  cover- 
ed with  a  strong  fascia. 


The  muscles  lying  on  the  fore  arm,  are  generally  consid- 
ered very  difficult  for  a  student  to  understand ; — perhaps  the 
following  plan  of  arranging  them  in  numbers,  will  obviate 
some  of  the  difficulties.  If  we  take  the  biceps  flexor  as  a 
.supinator,  which  it  truly  is,  and  the  mass  of  the  flexor  mus- 
cles (on  the  fore  arm)  as  one  great  pronator,  for  such  is 
their  conjoint  operation,  then  the  muscles  will  go  in  threes, 
thus  : 

For  the  .motion  of  the  wrist,  three  flexors,  the  ulnari&, 
mdialis,  and  medius  (commonly  called  palmaris  longus) ; 
three  extensors — ulnaris^  radiatu,  longior,  and  brevior  : 
three  pronators, — the  teres,  quadratus,  and  the  mass  of  the 
.flexor  muscles ;  three  supinators, — the  supinator  longust 
brevis,  and  biceps  cul-iti. 

There  are  three  extensors  of  the  fingers,  viz.  extensor  com- 
munis  digitoruify  extensor  primi  digi/i,  and  extensor  minimi 
digiti;  three  extensors  of  the  thumb, — extensor  primus, 
sc'cimdus,  and  terlius ;  three  flexors  of  the  fingers  and 
thumb,— -flexor  digitorum,  sublimis,  flexor  digitorum  profun*- 
d us,  flexor  pollici-s  longus. 

In  describing  the  muscles  of  the  fore  arm,  it  is  nearly  cor- 
rect to  say,  that  the  flexors  and  pronators  arise  from  the  in- 
ner condyle,  and  the  extensors  and  supinators  from  the  outer 

*  The  third  head  is  sometimes  called  brachialis  internu^ 
and  then  the  two  first  heads  arc  described  as  forming  a  &K 
reps  extensor. 


317 

ondyle  :  but  the  supinators  and pronalors  will  be  more  pro- 
perly distinguished  by  their  insertions,  as  all  muscles  which 
turn  the  hand  must  be  inserted  into  the  radius :  as  for  exam- 
ple,— the  wpinator  longus,  the  supinator  brevis,  the  pronator 
icrcS)  the  pronator  quadratus. 

TABLE  OF  THE  MUSCLES  LYING  ON  THE 
FORE  ARM. 

FLEXORS    OP    THE    WRIST. 

FLEXOR  CARPI  RADTALIS.  Oa.  The  internal  cpndyle  oj' 
the  os  humeri,  and  from  the  fore  and  upper  part  of  the  ulna. 

IN.  The  fore  and  upper  part  of  the  metacarpal  bone  that 
sustains  the  fore  finger, — runs  over  the  os  trapezium. 

FLEXOR  CARPI  ULNARIS.  OR.  The  internal  condylu  oi 
the  os  humeri,  and  side  of  theolecranon,  and  from  the  fascia- 

IN.  The  os  pisiform,  and  ligament  of  the  wrist. 

FLEXOR  CARPI  MEDIUS,  OR  PALMARIS  LONGUS.  OR. 
The  internal  condyle  of  theos  humeri,  from  the  intermuseu- 
lar  ligament  :  it  forms  a  neat  small  belly,  and  by  a  long  slen- 
der tendon,  has — 

IN.  Into  the  annular  ligament  of  the  wrist,  and  palmar 
aponeurosis. 

EXTENSORS    OF     THE    WRIST. 

EXTENSOR  CARPI  RADIALIS  LONGIOR.  OR.  From  the  low  - 
er  part  of  the  external  ridge  of  the  os  humeri,  above  its  ex- 
ternal condyle,  and  below  the  supinator  radii  longus. 

IN.  The  back  and  uppar  part  of  the  metacarpal  bone  that 
sustains  the  fore  finger. 

EXTENSOR  CARPI  RADIALIS  BREVIOR.  OR.  1.  the  ex- 
ternal condyle  of  the  os  humeri ;  2.  the  ligament  that  con- 
nects the  radius  to  it. 

IN.  The  upper  and  back  part  of  the  metacarpal  bone  that 
sustains  the  middle  finger. 

EXTENSOR  CARPI  ULNARIS.  OR.  1.  The  external  con- 
dyle of  the  os  hurneri ;  2.  the  ulna,  from  its  posterior  bor- 
ber. 

IN. 'The  posterior  and  upper  part  of  the  matacarpal  bone 
that  sustains  the  little  finger.  > 

MULCLES   OP    SUPINATION    AND    PRONATION. 

PROPER  SUPINATORS  ;  that  is,  those  which  turn  t 
af  the  hand  upward,  and  have  no  other  office. 


318 

SUPINATOR  RADII  LONGUS.    OR.  The  external  ridge  of 
the  os  bumeri,  nearly  as  far  up  as  the  middle  of  that  bone. 
IN.  The  lower  end  of  the  radius,  on  its  outer  side. 

SUPINATOR  RADII  BREVIS.  OR.  1.  From  the  external 
condyle  of  the  os  humeri ;  2.  from  the  external,  and  upper 
part  of  the  ulna  ;  3.  the  ligament  which  joins  these  two 
bones. 

IN.  The  neck  and  tubercle  of  the  radius,  and  ridge  run- 
ning downwards  from  the  tubercle. 

PRONATORS  ;  that  is,  which  throw  the  palm  of  the  hand 
prone  to  the  ground. 

PRONATOR  RADII  TERES.  OR.  1.  The  internal  condyle 
of  the  humerus  ;  2.  tendinous  from  the  coronoid  process  of 
the  ulna. 

IN.  The  outside  of  the  radius,  about  the  middle  of  the 
bone. 

PRONATOR  RADII  QUADRATUS.  OR.  The  lower  part  of 
the  ulna  :  the  belly  of  the  muscle  runs  transversely. 

IN.  The  lower  and  outer  part  of  the  radius. 

MUSCLES  MOVING    THE    FINGERS,  LYING  ON 
THE  FORE  ARM. 


FLEXOR  SUBLIMIS  PERFORATUS.  OR.  1.  The  internal  eon- 
ilyleof  the  os  humeri;  2.  the  coronoid  process  of  the 'ulna; 
3.  the  tubercle  of  the  radius;  4.  the  middle  of  the  fore  part 
of  the  radius,  where  the  flexor  pollicis  lorigus  arises.  The 
tendons  pass  under  the  ligament  of  the  wrist. 

IN.  The  second  bone  of  each  finger,  being,  near  its  ex- 
tremity, divided  for  the  passage  of  the  tendons  of  the  per- 
forans,  or  profundus. 

FLEXOR  PROFUNDUS  PERFORANS.  OR.  1.  The  side  and 
upper  part  of  the  ulna;  2.  from  a  large  share  of  the  interos- 
seous  ligament,  and  remotely  through  the  fascia  from  the 
inner  condyle ;  its  tendons  pass  under  the  annular  ligament 
of  the  wrist,  and  then  pass  through  the  slits  in  the  tendons 
'.»f  the  flexor  sublimis. 

IN.  Last  bones  of  the  four  fingers. 

FLEXOR  LONGUS  POLLICIS  MANUS.  OR.  1.  The  side  of 
f  he  coronoid  process  of  the  alna  ;  2.  the  radius,  immediately 
below  its  tubercle  ;  it  is  continued  down  for  some  space  on 
»Ue  fore  part  of  the  bone  ;  3.  the  interosseous  ligament:  its- 
"  pfldon  passes  under  the  ligament  of  the  wrist.  It  has  an 


319 

rigin,  frequently,  from  the  internal  eondyle  of  the  os  humeri. 
IN.  The  last  bone  of  the  thumb. 

EXTENSOR   MUSCLES   OF    THE    FINGERS    AND    THUMB* 

EXTENSOR  DIGITORUM  COMMUNIS.  OR.  1.  From  the 
<  'xternal  condyle  of  the  os  humeri,  where  it  adheres  to  the 
supinator  radii  brevis.  Before  it  passes  under  the  ligamen- 
turn  carpi  annulare  externum,  it  splits  into  four  tendons, 
some  of  which  may  be  divided  into  several  smaller.  On  the 
back  of  the  hand,  the  tendons  are  often  united  by  inter- 
change of  tendinous  filaments. 

IN.  The  posterior  part  of  the  bones  of  the  fingers,  by  a 
tendinous  expansion. 

USE.  To  extend  all  the  fingers. 

EXTENSOR  MINIMI  DIGITI.  OR.  The  external  condyle ; 
the  fascia  of  it  adheres  to  the  common  extensor. 

IN.  The  last  bone  of  the  litttle  finger. 

INDICATOR,  OR  EXTENSOR  PRIMI  DIGITI.     OR.  The  mid 
die  of  the  back  part  of  the  ulna  ;  its  tendon  passes  under  the 
same  ligament  with  the  extensor  digitorum  communis,  with  ' 
part  of  which  it  is — 

IN.  Into  the  posterior  part  of  the  fore  fing'er. 

EXTENSOR  PRIMI  INTERNODII   POLLICIS  MANUS,  VEL  Os- 
sis  METACARprPoLLicis.     OR.  1.  The  middle  and  poster! 
or  part  of  the  ulna,  immediately  below  the  insertion  of  the 
a.nconeous  muscle  ;       2.  the  back  part  of  the  middle  of  the 
radius  ;  3.  the  interosseous  ligament. 

IN.  (By  two  tendons)  into  the  os  trapezium,  and  uppci 
back  part  of  the  metacarpal  bone  of  the  thumb,  and  often 
joins  with  the  abductor  pollicis. 

USE.  To  draw  the  metacarpal  bone  of  the  thumb  out- 
wardly. 

EXTENSOR  SECUNDI  INTERNODII.  OR.  1.  The  back  parf 
of  the  ulna,  near  the  former  muscle ;  2.  the  interosseous  liga- 
ment. 

IN.  The  posterior  part  of  the  first  bone  of  the  thumb :  part 
of  it  may  be  traced  as  far  as  the  second  bone. 

USE.  To  extend  and  draw  the  "second  bone  of  the  thumb 
outwards. 

EXTENSOR  TERTII  INTERNODIT.     OR.  1.  The  middle  and 
back  part  of  the  ulna;  2.  from  the   interosseous  H 
its  tendon  runs  through  a  small  groove,   at  the  inner 
back  part  of  the  lower  end  of  the  radius. 

IN.  The  last  bone  of  the  thumb. 

•USE-.  To  extend  the  last  joint  of  the  thumb. 


320 

The  variety  of  motions  which  we  are  enabled  .to  execute 
with  the  fingers,  is  sufficient  evidence  of  the  complication 
of  the  small  muscles  which  lie  on  the  hand.  If  we  first 
make  an  arrangement  of  the  muscles  which  move  the  thumb, 
and  those  which  move  the  little  finger,  there  will  not  be 
much  difficulty  in  recollecting  the  other  muscles. 

We  find  a  muscle  for  pulling  the  thumb  from' the  fingers, 
Abductor  PoUicis:  one  for  drawing  the  thumb  towards  the 
fingers,  Adductor  Pollicis  :  and  to  .bend  the  thumb,  Flexor 
Hrevis: — with  this  muscle  may  be  classed  the  one  called 
Opponent)  of  Flexor  Ossis  Meiacarpi  Pollicis. 

For  the  little  finger  we  have  an  Abductor,  Adductor,  and 
Flexor.  There  still  remain  the  small  muscles  which  bend 
all  the  fingers,  viz.  the  Lumbricales.  There  is  also  a  set  of 
muscles  which  lie  between  the  metacarpal  bones  ;  these  are 
called  Interossei  Externi  and  Intcrni  ;  the  use  of  which,  is, 
to  draw  the  fingers  separate  .-  with  this  class  may  be  arrang- 
ed the  muscle  called  Abductor  Indicis  ;  as  it  lies  between 
the  metacarpal  bone  of  the  fore  finger,  and  that  of  the 
thumb. 

There  is  one  muscle  omitted  in  this  arrangement,  be- 
cause it  stands  by  itself, — the  Pa'maris  Brevis ;  being  the 
>et  of  fibres  which  were  seen  on  the  palmar  aponeurosis,  and 
covering  the  muscles  of  the  little  finger. 

TABLE  OF  THE  MUSCLES  OF  THE  HAND. 

'  PALMARIS  BREVIS.  On.  The  ligamentum  carpi  annu- 
!aro,  and  tendinous  membrane  that  is  expanded  on  the  palm 
of  the  hand. 

IN.  Into  the  skin  and  fat  that  cover  the  abductor  minimi 
digiti,  and  into  the  os  pisiforme. 

"USE.  To  assist  in  contracting  the  palm  of  theha'nd:  to 
sustain  the  grasp  of  the  hand. 

MUSCLES  WHICH  FORM  THE  BALL  OF  THE 
THUMB. 

ABDUCTOR  POLLICIS.  OR.  The  os  trapezium  :  and  liga- 
ment of  the  carpus. 

IN.  Root  of  the  second  bone  of  the  thumb. 
USE.  To  separate  the  thumb  from  the  fingers. 

OPPONENS  POLLICIS.  (Under  the  last.)  OR.  Os  trapezium, 
and  ligament  of  the  carpus. 

IN.  First  bone  of  the  thumb,  or,  metacarpal  of  the  thumb, 
as  it  is  sometimes  called. 

IT?E.  To  bring  the  thumb  towards  the  palm  and  fingers- 


321 

PLEXOR  BaEVia  POLLICIS.  (Divided  by  the  tendon  of  tin* 
long1  flexor.)  OR.  1.  Os  trapezoidee;  2.  os  magnum;  3.  os 
unciforme. 

IN.  Ossa  sesamoidea,  and  second  bone  of  the  thumb. 

USE.  To  bend  the  thumb. 

ADDUCTOR  POLLICIS.     OR.  From  the  metaearpal  bone  oi' 
the  middle  fidger. 
IN.  First  phalanx  of  the  thumb,  at  its  carpal  extremity. 

MUSCLES  OF  THE  LITTLE  FINGER. 

ABDUCTOR  MINIMI  DIGITI.  OR.  Os  pisiforme  and  liga- 
ment of  the  carpus. 
IN.  The  side  of  the  first  bone  of  the  little  finger. 

FLEXOR  PARVUS  MINIMI  DIGITI.     OR.  The  ulnar  side  of 
the  os  unciforme  and  ligament  of  the  wrist. 
IN.  First  bone  of  the  little  finger. 
USE.  It  is  an  assisting  flexor  of  the  little  finger. 

ADDUCTOR  MINIMI  DIGITI.  OR.  Edge  of  the  os  unci- 
ibrme,  and  ligament  of  the  wrist. 

IN.  The  side  of  the  metaearpal  bone  of  the  little  finger. 
USE.  To  draw  the  little  finger  towards  the  others. 

LUMBRICALES.  These  are  four  muscles,  lying  in  the  palm 
of  the  hand,  thin  and  fleshy,  so  as  to  resemble  earth  worms. 
Each  of  these  muscles  may  thus  be  described;  OR.  One  of 
the  tendons  of  the  flexor  profundus  digitorum. 

IN.  The  sheath  on  the  back  of  the  fingers,  along  with  the 
interossei. 

USE.  To  move  the  finger  on  the  metaearpal  bone. 

ABDUCTOR  INDICIS.  OR.  Os  trapezium,  and  metaearpal 
bone  of  the  thumb. 

IN.  The  first  bone  of  the  fore  finger. 

USE.  To  bring  the  fore  finger  towards  the  thumb. 

INTEROSSEI  INTERNI.  These  are  muscles  lying  deep  be* 
twixt  the  metaearpal  bones,  each  having  its  origin  thus :  OR. 
By  one  head,  from  a  metaearpal  bone. 

IN.  Into  the  sheath  of  the  extensor  muscles  on  the  back 
of  the  first  phalanx. 

INTEROSSEI  EXTERNI.  These  are  bicipites,  and  lie  on  the 
back  of  the  hand,  but  betwixt  the  metaearpal  bones.  OR., 
The  roots  of  the  metaearpal  bones. 

IN.  The  tendinous  expansion  of  the  extensor  communis. 

The  PRIOR  INDICIS  is  a  muscle  of  the  same  character  with 
fte  former,  only  that,  lying  on  the  radial  edge  of  the  met  a- 


322 


i-arpal  ofKthe  fore  finger,  it  cannot  be  so  properly  called  an, 
mterosseous,  as  those  which  are  seated  betwixt  the  metacar- 
pal  bones. 

USE  OF  THE  INTKROSSII.  While  there  seems  much  rea- 
son in  the  supposition,  that  the  lumbricales,  being1  small  mus- 
<  :les,  are  better  calculated  for  the  quick  movements  of  the 
lingers,  (whence  they  have  been  called  fidicinales  ;)  the  in- 
terossei  interni,  and  externi,  are  for  the  lateral  movements 
of  the  fingers,  or  the  adduction,  and  abduction  of  the  fingers, 
»nd  are  of  the  same  class  with  the  adductors  and  abductors 
uf  the  thumb  and  little  finder. 


DISSECTION 


LIGAMENTS  OF  THE  ARM. 


AFTER  having  completed  the  dissection  of  the  muscles  of 
f.he  arm,  we  should  remove  them,  that  we  may  examine  the 
ligaments  ;  and  in  doing  this,  we  should  take  the  opportuni- 
ty of  again  comparing  their  origins  and  insertions  with  the 
description  in  the  Table.  We  should  not  remove  every  part 
of  the  tendons  of  the  muscles  which  are  attached  to  the  head 
of  the  humerus  ;  for  they  are  so  intimately  connected  with 
fhecapsular  ligament,  that  we  shall  destroy  it  in  the  attempt, 

The  ligaments  about  the  shoulder  may  be  divided  into  three 
sots: — 1.  into  those  which  connect  the  clavicle  and  scapula; 
2.  the  ligaments  which  pass  from  one  point  of  the  scapula  to 
the  other;  3.  the  ligaments  connecting  the  humerus  and  sca- 
pula. 

When  the  fibres  of  the  deltoid  are  removed,  slips  of  liga- 
ment will  be  seen  passing  from  the  clavicle  upon  the  acromi- 
on ;  these  are  called  Ligamenta  Radiata.  There  is  also  a  proper 
capsular  ligament,  and  occasionally  an  intermediate  carti- 
lage between  the  acromion  and  clavicle;  but  the  principal 
ligaments  pass  between  the  coracoid  process  and  the  clavi- 
cle :  one  will  be  found  running  from  the  root  of  the  process 


323 

up  to  the  tubercle  on  the  lower  part  of  the  clavicle,  andfrou< 
its  round  shape,  it  is  called  Hgctmentum  conoides  ;  another, 
but  of  a  more  square  form,  rims  from  the  root  to  the  lower 
part  of  the  clavicle,  extending  from  the  last  ligament  to  near 
the  acromial  end  of  the  clavicle;  this  is  called  ligamtnhnlt 
trapezoides. 

The  ligaments  which  run  between  the  points  of  the  sca- 
pula, are  very  simple :  one,  of  a  triangular  form,  will  be  found 
attached  to  almost  the  whole  length  of  the  coracoid  pro* 
from  which  it  passes  to  the  tip  of  the  acromion  (it  is  some 
times  divided  into  two  portions,  by  a  little  cellular  membra1 
this,  from  its  shape,  is  called  ligammium  hi angular?.,  or 
toides.     By  removing  the  fibres  of  the  supra  spinatus  mu 
we  shall  discover  a  small  ligament  running  from  the  root  of 
the  coracoid  process  across  the  notch  ;  this  is  the  ligamen- 
tum  posticum  (the  supra  scapular  nerve   almost  always  pas- 
ses  under  the  ligament,  and  the  artery  generally  over  it.) 
The  ligaments  which  run  between  the  points  of  the  scapula, 
are  called  the  proper  ligaments  ;  while  those  which  corn 
the  clavicle  and  scapula,  are  called  the  common. 

In  dissecting  the  muscles  which  pass  from  the  scapula  tu 
the  head  of  the  humerus,  we  saw  the  supra  spinatus,  tin- 
infra  spinatus,  and  teres  minor,  all  spreading  their  tendons 
upon  the  upper  surface  of  the  thin  capsule :  and  on  the  lower 
part,  we  might  have  seen  the  ligament  strengthened  by  th»- 
tendon  of  the  subscapularis.  If  we  now  dissect  away  all 
these  tendons,  the  capsule  will  appear  as  a  transparent  mi 
brane,  rising  from  the  edge  of  the  glenoid  cavity,  and  pas- 
sing down  to  surround  the  neck  of  the  humerus. 

This  view  must  prove  to  us,  that  the  strength  of  this  joint 
does  not  consist  in  its  capsular  ligament,  but  in  the  tor. 
of  the  muscles  which  surround  it. 

In  examining  the  capsule,  in  a  superficial  manner, 
pears  to  be  perforated  by  the  tendon  of  the  long  head  of  tie 
biceps  ;  but  when  the  capsule  is  opened,  we  shall  find  tl 
very  thin  portion  of  the  membrane  passes  down  into  th- 
cipital  groove,  and  is  then  reflected  on  the  tendon  of  th- 
cepS) — So  that  the  tendon  is  actually  external  to  tho  liga- 
ment. 

When  we  cut  open  the  joint,  we  shall  see  that  the  glenoid 
cavity  is  deepened  by  a  ring  of  fibrous  cartilaginous  ligament 
surrounding  its  edge.     We  should  not  omit  to  look  for 
large  bursay  which  is  between  the  deltoid  and  the  capsulai 
ligament. 

The  ligaments  of  the  elbow  joint  are  a  little  complicated, 
in  consequence  of  the  head  of  the  radius  entering  into  the 
articulation  ;  but  still,  as  the  joint  is  nearly  a  simple  hr 


324 

the  principal  ligaments  will  be  lateral.  We  shall  find  here* 
as  in  all  other  joints,  a  capsular  ligament ;  but  its  appear- 
ance is  not  that  of  a  thin  membrane,  except  at  the  posterior 
part,  in  consequence  of  its  being  covered  both  on  the  fore 
and  lateral  parts,  by  slips  of  ligament  from  the  tendons  of 
the  muscles  :  those  on  the  fore  part  are  called  accessoria  a?i- 
tica  ;  while  those  on  the  sides  are  described  as  distinct  fate* 
-ral  ligaments. 

The  external  lateral  runs  from  the  external  condyle  to  tht 
internal,  and  may  be  divided  into  two  parts,  we  shall  easily 
distinguish ;  for  one  portion  restrains  the  joint,  when  it  is 
bent  to  a  certain  extent ;  and  the  other  checks  it,  when  it  is 
too  much  extended. 

The  radius  is  articulated  with  the  external  condyle  ;  but 
by  rolling  it,  we  shall  see  that  it  is  also  connected  with  the 
ulna,  by  a  thickening  of  the  general  capsular  ligament, 
which  is  called  ligamentum  coronaritim.  In  taking  off  the 
muscles,  to  show  the  interosseous  ligament,  we  must  take  care 
that  we  do  not  cut  the  ligamentum  obliquum,  or  transversale^ 
which  runs  from  the  ulna  to  a  point  of  the  radius,  below  the 
tubercle. 

The  wrist  is  rather  a  complicated  joint ;  but  as  the  move- 
ments between  the  bones  of  the  carpus  and  bones  of  the  fore 
arm,  are  principally  flexion  and  extension,  we  shall  have  on 
the  inside  and  outside,  lateral  ligaments  ; — these  ligament? 
are  very  loose  and  much  connected  with  the  general  capsule . 
which  will  be  found  to  be  very  strong,  in  consequence  of  the 
many  slips  which  cross  it.  The  capsular  ligament  does  not 
bind  the  bones  very  closely  together,  but  allows  of  a  very 
considerable  degree  of  lateral  motion. 

When  we  open  the  capsular  ligament,  we  shall  find  that 
the  end  of  the  ulna  does  not  correspond  exactly  to  the  cune« 
fbrm  and  lunar  bones,  but  that  there  is  a  portion  of  cartilage 
tnterposed  between  them.  We  may  now  separate  the  car* 
pus  from  the  radius  and  ulna,  and  then  examine  the  connex- 
ion which  is  between  these  two  bones.  The  convexity  of 
the  head  of  the  ulna  will  be  found  attached  to  the  concavity 
on  the  radius,  by  a  coronary  ligament,  which,  however,  IF 
Called  ligamentum  sacciforme,  or  membrana  sacciformis. 

The  carpal,  and  the  heads  of  the  metacarpal  bones,  are 
connected  together  by  capsular  ligaments  and  by  accessory 
slips,  which  are  easily  dissected  :  it  would  be  needless  to  give 
them  separate  names.  The  metacarpal  bones,  and  the  seve? 
ral  phalanges  of  the  ringers,  are  united  by  capsular  and  lateral 
ligaments,  which,  though  very  simple,  ought  to  be  carefully 
studied, — as  the  dislocations  of  the  finger,  and  particularly 
of  the  thumb;  are  sometimes  very  troublesome. 


325 

DISSECTION 

OP 

THE  ARTERIES 

O'F 

THE  SHOULDER  AND  ARM. 


IN  the  first  dissection  of  these  arteries,  they  should  be  in- 
jected ;  and  that  all  the  vessels  of  the  shoulder  may  be  seen, 
'the  injection  should  be  made  in  the  same  manner  as  that  de- 
scribed at  p.  241.  It  may  be  done  from  the  subclavian  arte- 
ry, or  from  the  axillary,  after  the  arm  is  removed  from  the 
"body  :  but  in  either  of  these  methods,  a  great  many  vessels 
mus't  necessarily  be  destroyed. 

The  manner  of  dissecting  the  arteries  which  arise  from 
the  subclavian,  has  already  been  described  at  page  243  ;  st> 
we  may  now  pass  to  the  description  of  the  branches  which 
arise  from  the  artery,  after  it  has  passed  under  the  clavicle  ; 
-and  first,  of  that  division  of  the  artery  which  is  called  the  Ax- 
illary. 

The  pectoralis  major,  the  deltoid,  and  the  latissimus  dorsJ, 
should  be  dissected  in  the  manner  recommended  in  the  dis- 
section of  the  muscles,  at  page  199  ;  but  in  doing  this,  we 
must  take  care  to  avoid  the  small  branches  which  will  be 
found  on  removing  the  cellular  membrane.  If  we  are  dis- 
secting a  female  subject,  in  which  the  breasts  are  enlarged, 
*>r  where  milk  has  lately  been  secreted,  we  shall  find  upor». 
the  surface  of  the  pectoralis  major  a  great  many  arteries  pass- 
ing to  the  mamma. 

"Between  the  deltoid  and  pectoralis,  we  shall  see  arteries 
running  down,  and  a  vein  passing  up; — the  arteries  af» 
branches  of  the  T/wracica  Humeraria  ;  the  vein  is  the  Ce- 
yhatic.  On  the  lower  edge  of  the  pectoralis,  and  upper  edgj? 
of  the  latissimus  dorei,  branches  of  the  Thoracica  Alaris  and 
of  the  Subscapular,  will  be  found.  By  dissecting  between 
the  two  muscles,  we  shall  expose  the  axilla,  in  which  .we 
«hall  see  a  net-work  of  vessels  and  nerves,  complicated  with 
many  lymphatic  glands.  In  considering  the  surgical  anato- 
•*iy,  all  the  parts  of  the  axilla  will -excite  much  interest ;  but. 

Bd 


326 

at  present  we  should  trace  the  branches  of  the  arteries  only 
through  it. 

That  we  may  follow  the  arteries  more  easily,  we  should 
now  raise  part  of  the  pectoralis  major  from  its  origins.  In 
doing  this,  we  shall  be  obliged  to  cut  through  many  branches : 
some  of  these  come,  through  the  intercostal  muscles,  from 
the  mammaria  interna  ;  but  the  principal  ones  are  branches 
of  the  Thoracica  Longior,  or  Mammaria  Externa^  which, 
when  the  muscle  is  farther  raised,  will  be  seen  rising  in  com- 
mon with  the  Thoracica  Humeraria,  or  Acromialis ;  the 
branches  of  which  have  already  been  observed  passing  be- 
tween the  deltoid  and  pectoralis  major. 

The  muscle  may  now  be  completely  thrown  back,  and 
then  the  pectoralis  minor  will  be  exposed.  A  small  artery 
will  now  be  seen  passing  into  the  space  between  the  first  and 
second  ribs ; — this  is  called  the  Thoracica  Prima,  or  Supe- 
rior. On  the  lower  edge  of  the  pectoralis  minor,  some 
branches  will  be  seen  running  into  the  fat  and  glands  of  the 
axilla, — which  must  be  carefully  followed,  by  dissecting  them 
with  the  forceps  andscissars.  These  branches  are  describ- 
ed as  coming  from  one  trunk,  which  is  called  the  Thoracica 
Jllaris  ;  but  they  generally  arise  in  two  or  three  small  branch- 
es. 

The  trunk  of  the  artery  may  now  be  fully  exposed.  It  will 
be  found  covered  by  the  veins,  but  lying  below  the  level  of 
the  axillary  nerves.  Until  it  has  fairly  passed  under  the 
pectoralis  minor,  there  will  be  no  difficulty  in  separating  it. 
from  the  plexus  of  nerves  ;  but  immediately  after  it  passes 
this  muscle,  it  will  be  found  to  be  completely  enveloped  in 
the  plexus.  The  arm  must  then  be  bent ;  which  will  relax 
the  plexus,  and  enable  us  to  dissect  the  cellular  membrane 
from  between  the  artery  and  nerves. 

When  the  artery  comes  opposite  to  the  upper  part  .of  the 
insertion  of  the  latissimus  dorsi,  it  gives  off  the  Subscapulw 
artery,  which  will  be  found  to  pass  under  the  scapula,  and  to 
give  off  numerous  branches  to  the  serratus  magnus,  subscap- 
ularis, latissimus  dorsi,  &c.  ;  and  frequently  to  the  axillary 
glands.  We  should  now  observe  the  beginning  of  a  branch, 
which  we  cannot  follow  to  its  termination  until  the  body  j* 
turned  or  the  arm  separated.  This  will  afterwards  be  found 
to  run  to  the  dorsum  of  the  scapula  ;  whence  it  is  called  the 
Dorsalis  Scapulae. 

As  the  main  trunk  is  so  covered  by  the  plexus,  at  the  point 
where  it  gives  off  the  subscapularis,  we  shall  probably  not  at 
once  discover  the  Posterior  Circumflex ;  which  rises  close  to 
the  trunk  of  the  subscapularis,  and  sometimes  in  union  with 
it.  After  we  have  found  this  artery,  we  shall  not  be  able  to 


327 

follow  it  far  in  the  present  position  of  the  limb,  as  it  passes 
between  the  long  head  of  the  biceps  and  humerus,  to  be  dis- 
tributed on  the  deltoid.  Its  branches  will  be  seen  on  dis- 
secting the  back  part  of  the  arm. 

We  generally  find  another  artery,  which  passes  to  the  an- 
terior part  of  the  joint,  rising  immediately  opposite  to  the 
the  last ;  it  is  called  the  Anterior  Circumflex.  The  plexus  of 
nerves  must  be  pulled  down  to  expose  it.  Jt  is  a  small  ves- 
sel, and  generally  runs  between  the  tendons  of  the  pectoralis 
major  and  the  capsular  ligament. 

We  shall  now  have  traced  the  main  trunk  fairly  past  the 
insertion  of  the  pectoralis  major  and  .latissimus  dbrsi ;  and 
here  its  name  is  changed  to  Humeral  or  Brachial,  which  it, 
retains  until  it  reaches  the  elbow. 

The  dissection  of  the  portion  between  the  scapula  and  el- 
bow is  very  easy.  If  we  do  not  wish  to  keep  the  arm  and 
chest  connected,  we  may  now,  without  hurting  any  vessels, 
separate  the  arm  from  the  body. 

Before  following  the  trunk  of  the  artery,  we  should  turn 
the  arm  round,  and  make  a  superficial  dissection  of  the  mus- 
cles lying  on  the  scapula.*  In  dissecting  the  deltoid,  seve- 
ral of  the  branches  of  the  thoracica  humeraria,  and  of  thecir- 
cumflexa  posterior,  will  be  found.  There  will  also,  perhaps, 
be  several  branches  of  the  supra  scapularis  (which  is  some- 
times a  prolongation  of  the  Transversatis  Colli,  described  at 
page  243,)  passing  into  the  substance  of  the  supra  spkiatus 
muscle. f  On  the  muscles  below  the  spine,  many  branch- 
es of  the  dorsal-is  scapulce^  and  of.  the  subscapularis,  will  be 
found.  All  those  arteries  which  pass  to  the  scapula,  are 
distributed  so  much  on  the  surface  of  the  bone,  that,  before 
we  can  show  them,  it  will  be  necessary  to  remove  the  mus- 
cular fibres. 

The  superficial  dissection  which  has  been  begun  on  the 
deltoid,  may  be  continued  down  upon  the  triceps.  As  we 
approach  the  elbow,  we  must  carefully  avoid  the  superficial 
branches,  for  they  form  inosculations  with  those  of  the  fore 
arm.  Those  on  the  external  part,  are  branches  from  the  cir- 
cumflexa  posterior,  and  the  profunda  superior  ;  while  those 
on  the  inside,  are  from  the  profunda  inferior,  and  the  anas- 
tomotica. 

*  This  may  be  done  without  separating  the  arm  from  the 
body,  by  throwing  the  arm  over  the  chest. 

f  Wrhen  there  is  this  arrangement  of  the  artery,  it  very 
seldom  passes  under  the  ligamentum  posticum.  It  appears 
to  pass  under  the  ligament,  only  when  it  arises  from  the  sub- 
clavian,  as  a  distinct  branch,  and  low  down. 


328 

We  may  now  turn  the  arm,  and  continue  the  dissection  of 
the  trunk.  An  incision  is  to  be  made,  down  to  the  elbow, 
in  the  course  of  the  artery  :  when  the  skin  is  dissected  off; 
a  thin  facia  will  be  seen  to  pass  from  the  inside  of  tkc  triceps 
to  the  biceps  ;  when  this  is  opened,  the  trunk  will  be  seen  on 
the  inside  of  the  biceps, — not  now  enveloped  in  a  plexus  of 
nerves,  but  with  the  radial,  or  median  nerve,  lying  close  up- 
on the  inner  side  of  it. 

The  first  branch  (which  has  a  name)  we  shall  find,  by' 
looking-  for  the  muscular  spiral  nerve,  or  between  the  heads 
of  the  triceps. — The  artery  is  called  the  Profunda  Superior; 
we  may  trace  it  into  the  deep  parts  of  the  arm,  by  following 
it  along  with  the  nerve. 

We  may  now  for  a  moment  disregard  the  branches,  and 
trace  the  trunk  to  the  elbowr,  taking  care  not  to  cut  any  ves- 
sels. On  the  side  of  the  artery  next  to  the  biceps,  wre  shall 
see  a  great  number  of  branches  going  off;  these,  however-, 
are  merely  muscular  branches,  and  there  are  no  particular 
names  for  them.  The  only  one  of  these,  which  we  should 
particularly  observe,  is  a  trunk,  passing  off  at  the  lower  part 
ofthecoraco  brachialis  to  the  bone:  it  is  called  Nutriti<* 
Magrut  Humeri.  On  the  side  of  the  artery  nearest  to  the 
jbrachialis  internus,  we  shall  find  three,  four,  or  five  branches, 
all  taking  nearly  the  same  course  towards  the  inside  of  the 
elbow,  and  to  communicate  with  the  recurrent  arteries  of 
the  fore  arm.  The  upper  one  is  generally  called  the  Pro- 
funda Interior  ;  while  the  largest  of  those  below,  is  the  An- 
astomoticus  Magnus, — and  .the  next  in  size,  the  Anastomoii- 
cus  Minor. 

We  shall  now  have  traced  the  main  trunk  to  the  bend  of 
the  arm,  where  it  generally  divides  into  the  Radial  and  Ub- 
nar.* 

The  trunk  will  be  found  lying  close  by  the  edge  of  the  bi- 
ceps, and  passing  under  the  portion  of  its  tendon  which  is  in- 
serted into  the  fascia  of  the  fore  arm.  .Before  following  the 
trunk,  we  should  make  a  dissection  of  the  fascia  of  the  fore 
arm ;  this  may  quickly  be  done,  by  making  a  cut  through 
the  skin,  from  the  elbow  to  the  wrist,  and  by  then  dissecting 
tbe  skin  off  from  all  around  the  arm.  We  need  not  preserve 
the  small  branches  which  perforate  the  fascia  to  supply  the 
skin  ;  but  we  must  take  care  of  branches  which  run  around 

*The  bifurcation  occasionally  takes  place  higher  upon  the 

arm  ;  but  in  what  proportion  of  instances,  Ihave  a  difficulty 

of  determining;  during  some  seasons  I  have  observed  it,  in 

-nearly  every  third  body.     I  think,  however,  it  may  be  saici" 

to  occur  in  a  proportion,  of  about  one  to  ten, 


329 

the  elbow,  and  of  any  small  branches  which  may  be  found 
near  the  wrist ;  for  the  arteries  there,  are  very  irregular. 

In  following  the  trunk,  and  the  commencement  of  the  ra- 
dial and  ulnar  arteries,  we  must  be  very  careful ;  as  there- 
is  always  a  quantity  of  fat  and  cellular  membrane  interposed 
between  the  tendons  of  the  biceps,  and  the  insertion  of  the 
brachialis  internus, — in  which  space,  the  artery  generally 
divides  :  to  see  it  distinctly,  we  must  cut  through  the  tendin- 
ous membrane  which  passes  from  the  biceps  to  the  fascia, 
of  the  fore  arm. 

As  the  Radial  lies  more  superficial  than  the  ulnar,  we 
should  first  trace  it  to  the  wrist.  This  will  be  very  easy  ; 
for  by  merely  cutting  through  the  fascia,  we  may  follow  the 
artery  over  the  tendon  of  the  pronator  teres,  towards  the  ra- 
dius, and  then  it  runs  down  parallel  with  the  bone,  lying  on 
the  flexor  pollicis  longus,  and  between  the  supinator  longus 
and  the  flexor  carpi  radialis.  We  need  not  here  enumerate 
the  several  branches  which  are  going  to  the  muscle  ;  for 
they  are  very  irregular;  but  we  should  particularly  mark 
the  branch  which  turns  back,  and  round  the  tendon  of  tho 
biceps,  to  pass  on  the  elbow :  this  is  the  Recurrens  Radialis. 
The  only  other  branch  of  importance,  is  that  which  is  given 
off  at  the  point  where  we  generally  feel  the  pulse ;  viz.  the 
Superjidalis  Voice. :  but  this  branch  is  very  irregular  in  its 
size. — We  should  not  now  trace  the  radial  farther,  but  return 
to  the  ulnar. 

The  ulnar  passes  much  deeper  than  the  radial ;  conse- 
quently, it  is  more  difficult  to  trace  its  branches.  It  will  be 
found  running  at  once  deep  into  the  arm,  to  pass  under  the 
pronator  teres.  While  the  artery  is  under  this  muscle,  we 
shall  often  find  a  branch  pass  off,  which  is  nearly  as  large  as 
the  ulnar  itself;  viz.  the  Interossea  Interna.  But  before  this 
great  trunk  is  given  off,  we  shall  generally  find  a  branch, 
running  back  to  the  elbow  ;  viz.  the  Recurrens  Ulnaris. — 
After  these  two  branches  are  seen,  the  trunk  may  be  traced 
down  to  the  wrist,  between  the  superficial  and  deep  layer  of 
the  muscles :  in  its  course,  it  gives  off'  many  branches, — the 
most  important  of  which,  will  be  enumerated  in  the  Table. 

We  should  now  trace  the  branches  of  the  interoseea,  for 
it  is  the  vessel  which  supplies  the  principal  parts  of  the  fore 
arm. 

The  trunk  has  already  been  seen,  coming  offftom  the 
ulnaf,  under  the  pronator  teres, — from  which,  we  may  now 
trace  it,  along  the  interosseous  ligament,  and  between  the 
flexor  digitorum  profun$us  and  flexor  pollicis.  But  we  shall 
generally  find,  that  almost  immediately  on  its  rising  from 
the  ulnar?  it  gives  off  a  large  branch,  which  may  be  traced? 


330 

through  the  ligament,  to  the  supinators  and  extensors,  and 
is  lost°  at  last,  on  the  back  of  the  hand.  But  before  thin 
(the  Interossea  Externa)  arises  from  it,  there  is  generally  a 
recwvent  sent  off,  to  inosculate  with  the  anastornatici  upon 
the  elbow. 

When  we  have  followed  the  internal  artery  as  far  down 
as  to  the  pronator  quadratus,  we  shall  find  it  divide  into  two 
vessels  ;  one  of  which  may  be  traced^  through  the  interosse- 
ous  ligament,  to  the  back  of  the  wrist, — while  a  smaller 
branch  is  continued  down  to  the  fore  part  of  the  bones  of  the 
carpus. 

The  arteries  of  the  hand  are  very  numerous,  and  very  com- 
plicated and  difficult  to  dissect ;  but  still  the  small  branches 
will  easily  be  understood  after  a  general  arrangement  is 
made.  We  should  commence  the  dissection,  by  raising  the 
skin  from  the  palm  of  the  hand,  so  as  to  expose  the  palmar 
aponeurosis.  On  removing  the  skin,  a  number  of  small 
branches  will  be  seen  ; — those  on  the  middle  and  outer  part, 
come  from  the  ulnar  ;  while  those  which  are  on  the  inside, 
and  on  the  muscles  of  the  thumb,  are  from  the  radial:  but 
here,  we  shall  probably  find  one  larger  than  the  others,  viz. 
the  Superfidalis  Voice,  When  the  skin  is  dissected  from 
the  back  of  the  hand,  the  main  trunk  of  the  radial  will  be 
found  passing  between  the  tendons  of  the  extensors  of  the 
thumb  ;  from  which,  it  passes  deep  between  the  abductor 
indicis  and  adductor  pollicis,  to  form  the  deep  arch. 

There  are  no  directions  required,  for  tracing  either  the 
ulnar  or  the  radial  artery;  farther  than  that  of  following 
them  patiently  from  trunk  to  branch,  with  the  forceps  and 
scissars. — In  the  first  dissection,  every  thing  is  to  be  cut 
away,  except  the  arteries  and  the  tendons. 

We  should  first  expose  the  Superficial  Jlrch,  which  is 
formed  by  the  ulnar  ;  and  then  the  Deep  Arch,  formed  by 
the  radial :  but  this,  we  shall  find  to  be  very  difficult.  The 
arteries  which  are  seen  on  the  back  of  the  wrist,  and  on  the 
thumb,  are  generally  from  the  external  interosseal,  and  the 
radial, 

TABLE  OF  THE  ARTERIES  OF  THE  SHOULDER 
AND  ARM. 

It  is  agreed  by  all  authors  (who  have  taken  the  description 
of  the  arteries  from  the  dissection  of  many  bodies,)  that  there 
are  no  vessels  more  irregular,  than  those  which  rise  from  the. 
subclavian.  Bu4-the  general  arrangement  is  very  simple  . 
for  we  have  here,  as  in  the  study  of  the  arteries  of  the  leg.. 


331 

r>nly  to  rec6llect,  that  the  names  of  the  branches  correspond 
to  the  parts  which  the  trunk  passes. 

The  following  sketch  will  be  found  to  agree,  in  most  re- 
spects, with  the  description  of  Haller  ;  and  I  have  attempt- 
ed to  make  the  arrangement  correspond  with  what  I  think  is 
most  commonly  seen  : — 

The  great  trunk,  in  its  course  from  the  aorta  to  the  fin- . 
gers,  receives  names  corresponding  to  the  parts  which  it  pas- 
ses. From  its  branching  off  from  the  aorta,  until  it  passes 
under  the  clavicle,  it  is  called  Subclavian.  From  the  upper 
edge  of  the  pectoralis  minor,  until  it  passes  the  insertion  of 
the  latissimus  dorsi  and  pectoralis  major, — Axillary.  From 
this  point,  until  the  division  at  the  bend  of  the  arm, — Hume- 
ral, or  Br  actual.  From  the  bend  of  the  arm  to  the  wrist, — 
Radial,  Ulnar,  and  Interosseal.  From  the  wrist  to  the  fin- 
gers,—-Superficial  Arch,  Deep  Arch,  and  Posterior  Arteries. 

The  names  which  are  given  to  the  branches,  refer  to  each 
division  of  the  trunk. 

The  branches  of  the  subclavian  have  already  been  enu- 
merated at  page  251. 

The  next  division  of  the  artery  is  the  Axillary :  from 
it,  we  have, — thoracica  superior ;  thoracica  longior,  or  mam- 
maria  externa  ;  thoracica  humeraria,  or  acromialis ;  thora- 
tica  alaris  ;  mbscapularis  ;  circumf.exa  posterior*  ;  circum- 
flex a  anterior. 

Thoracica  Superior,  gives  branches  between  the  first  and 
socond  ribs.  • 

Thoracia  Longior^ — to  the  pectoralis  major  and  mamma. 

Thoracica  Humeraria, — branches  between  the  pectoralis 
major  and  deltoid. 

Thoracica  Alaris, — to  the  fat,  glands,  pectoralis  minor,  &e. 

Subscapularis, — 1.  to  the  axilla  and  glands ;  2.  to  the.  sub- 
.ioapular  muscle;  3.  infra  scapular  branch  to  the  muscles  of 
the  back  ;  4.  dorsalis,  or  circumflexa  subscapularis,  to  the 
muscles  on  the  back  of  the  scapula. 

Circumflexa  Posterior, — branches  to  the  heads  of  the  tri- 
i'eps,  coraco  brachialis,  deltoid,  and  capsule. 

Circumflexa  Anterior,-—  to  fche  periosteum  and  capsule. 

The  third  division  of  the  artery  is  the  Humeral  or  Brachi- 
&1 ;  gives, — 1 .  a  set  of  small  branches  to  the  muscles  ;  2. 
profunda  humeri  superior  ;  3.  profunda  humeri  inferior  ;  4. 
ttnastomotica  magna. 

From  the  Set  of  small  Branches,  twigs  go  off  to  the  biceps 
and  brachialis  interims,  and  also  the  arteria  nutritia  humeri. 

Profunda  Superior, — 1.  to  the  muscles;  2.  radialis  commu- 
nicans,  to  the  external  condyle ;  3.  branches  to  the  back  of 
the  eibow;  to  unite  with  the  recurrens  interosjsea  and  radi- 


332 

Profunda  Inferior, — to  the  brachialis  interims  and  biceps  , 
2.  to  the  external  condyle  and  supinator ;  3.  to  the  ulriar 
nerve  and  back  of  the  elbow  joint. 

Anastomotica  Magna., — 1.  branch  communicating  with  the 
profunda ;  2.  descending  superficial  branch ;  3.  descending 
deep  branch  :  these  two  form,  with  the  recurrents  of  the  ar"- 
teries  of  the  fore  arm,  the  arcus  anterior ;  4.  transverse 
branch  which  goes  behind,  forming,  with  the  profunda  and 
recurrents,  the  circus  posterior. 

The  fourth  division  of  the  great  artery  is  into  the  Radial 
;ind  Ulnar. 

The  Radial  gives  off;  1 .  to  the  supinator  ;  2.  recurrens 
radialis  ;  3.  in  succession  to  the  supinator.,  pronator  and  flexor 
muscles  ;  4.  superficialis  voice  ;  5.  irregular  branches  to  the 
wrist  ;  6.  dorsalis  pollicis  ;  7.  dorsalis  carpi ;  8.  dorsalis  me- 
tacarpi;  9.  magna  pollicis:  10.  radialis  indicis  ;  11.  deep 
palmar  archy  which  inosculates  with  the  superficial  arch  from 
the  ulnar,  and  gives  off  the  interossea  to  the  metacarpal  spa- 
cos. 

Ulnaris, — gives  off  the  inferosseal  artery :  but  before  it 
does  so,  it  sends  off  some  smaller  ones. — 1.  to  the  pronator  ; 
2.  Perforans,  through  the  interosseous  ligament  to  the  back 
of  the  joint ;  3.  recurrens  ulnaris,  which  has  a  superficial 
and  deep  branch  ;  4.  arteria  nuiritia  ;  5.  interossea  commu- 
nis  (this  will  afterwards  be  considered  as  a  principal  branch,) 
t>.  irregular  branches  to  the  muscles  ;  7.  dorsalis  manus  ;  8.  to 
I  he  muscles  of  the  little  Jing-er  ;  9.  palmaris  profunda^  which, 
uniting  with  the  racial,  forms  the  deep  arch  ;  10.  superficial 
palmar  arch,  giving  ^ff  yolans  ulnaris  minimi  digiti,  digita- 
lis volans  prima,  digitalis  volans  secunda,  digitalis  volans 
tertia;  these  are  the  vessels  to  the  fingers  ;  ll.  communi- 
f'tfn*,  joining  the  radial,  on  the  thumb. 

Interossea  Communis  :  1.  to  the  muscles  and  ligaments  of 
the  joint;  2.  perforans  superior,  which  gives  off  ramus  de- 
scendens,  and  recurrens  interossea  ;  3.  irregular  branches 
to  the  flexor  muscles  :  4.  perforans  inferior ;  passes  through 
the  upper  edge  of  the  pronator  quadratus,  and  gives  branches 
to  the  back  of  the  wrist;  5.  interossea  volans  anterior,  or 
anterior  articular  artery  of  the  wrist. 


333 

DISSECTION 

OF  THE 

OF  THE  ARM: 


IT  is  almost  needless  to  inject  the  veins  of  the  arm,  unless 
it  be  for  the  purpose  of  making  a  preparation  ;  for  a  much 
better  knowledge  is  gained  of  the  course  of  the  superficial 
veins,  by  putting  a  ligature  round  the  arm  of  a  thin*  muscular 
man,  than  is  ever  done  by  injecting,  or  dissecting  them.  As 
the  deep  veins  all  accompany  the  arteries,  their  course  may 
also  be  easily  understood  ;  but  in  making  the  surgical  dis- 
section at  the  bend  of  the  arm,  it  will  be  useful  to  have  some 
of  the  veins  filled.  Though  I  do  not  think  it  neces^ry  for 
the  dissection,  I  shall  here  describe  the  manner  of  injecting 
the  veins,  that  they  may  be  preserved  : — 

In  consequence  of  the  numerous  valves  which  are  in  the 
veins,  it  will  be  impossible  to  inject  them  from  the  subclavi- 
an;  the  injection  must  be  thrown  in,  from  one  of  the  vessels 
on  the  hand.  Those  on  the  palm  are  so  small,  that  it  will 
be  needless  to  try  to  introduce  a  pipe  into  them.  We  must 
look  for  a  vein  on  the  back  of  the  hand.  That  vein  which 
runs  up  from  the  fore  finger,  or  the  one  between  the  little  and 
ring  finger,  will  generally  be  found  to  be  the  best.  After  we 
have  introduced  the  pipe,  a  piece  of  the  skin  over  the  vein, 
should  be  included  in  the  ligature ;  or  we  shall  be  in  danger 
of  tearing  the  coats  of  the  vein,  while  we  are  injecting  it. 

The  blood  is  to  be  first  thoroughly  pushed  out  of  the  veins, 
by  injecting  warm  water  into  them,  and  allowing  it  to  escape 
by  the  subclavian.  This  injection  of  warm  water,  should  be 
repeated  several  times ;  and  previous  to  the  injection  with 
the  wax,  the  water  should  be  forced,  out,  by  holding  the  arm., 
with  the  hand,  perpendicular  to  the  foody,  and  rubbing  the 
vessels,  down  towards  the  axilla.  A  ligature  may  be  put 
round  the  subclavian  vein  :  but  it  should  not  be  tied  until  the 
injection  is  thrown  in  from  below  ;  so  that  any  water  which 
may  not  have  been  forced  out,  may  be  pushed  before  the  in- 
jection; as  soon  as  the  wax  appears  &t  the-s«bclavian,  an  as- 
sistant should  tie  the  ligature.  The  injection  made  from  « 
single  vein,  will  very  seldom  be  successful, — we  may,  there  - 


334 

fore,  be  obliged  to  put  the  pipe  into  one  or  two  different  veins  \ 
but  if,  in  cleansing  the  veins  of  the  blood,  the  valves  be  much 
broken,  the  injection  may  pass  easily  from  one  vein  to  the 
other. 

The  dissection  of  the  veins  is  very  simple ;  for  all  the  cu- 
taneous veins,  when  distended  with  wax,  will  be  visible  ;  and 
to  expose  them,  it  will  be  only  necessary  to  remove  the  skin. 
As  the  deep  veins  follow  the  course  of  the  several  arteries, 
they  require  no  further  description.- 

If  the  injection  has  been  successful,  it  will  have  filled 
the  veins  of  the  hand  below  the  part  into  which  the  pipe, 
was  put; — a  plexus  will  be  found  running  between  the 
knuckles,  and  forming  an  arch  on  the  back  of  the  hand ; 

this  has  been   called  the  Plexus,  Dorsalis  Manus, and 

the  arch,  the  Arcus  Venoms  Dorsalis.  From  the  part 
of  the  arch  nearest  to  the  thumb,  and  from  a  vein  on  the 
thumb,  there  is  a  trunk  rises,  which  is  called  Vena  Ce- 
phalica  Pollicis ;  this  name  heving  been  given  to  it  by 
the  Arabian  anatomists,  from  the  idea  that  opening  it 
was  useful  in  diseases  of  the  head  ; — this  vessel,  when  joined 
by  pthi(r  veins  of  the  arch,  forms  a  trunk,  that  runs  up  the 
radial  edge  of  the  arm,  and  is  called  Vena  Cephalica  Minor, 
or  Radialis  Exierna  :  at  the  bend  of  the  arm,  this  is  joined 
by  the  ^Median  Cephalic  ;  and  by  this  union,  the  Great  Ceph- 
alic is  formed,  which  passes  up,  first  between  the  tendons  of 
the  biceps  and  triceps,  and  then  between  the  tendons  of  the 
pectoralis  major  and  deltoid,  to  dip  into  the  axillary  vein. 
The  large  vein,  which  is  on  the  ulnar  side  of  the  arm,  is  cal- 
led Basilica,  from  a  strange  fancy  of  the  ancients,  that  bleed- 
ing from  this,  was  a  sovereign  remedy  for  many  diseases  ; 
and  they  moreover  conceived,  that  the  vein  of  the  right  arm 
belonged  to  the  liver,  and  that  of  the  left,  to  the  spleen. 
This  vein  is  formed  by  the  vessels  of  the  arch  nearest  the 
little  finger,  and  by  the  vein  that  is  between  the  little  and 
ring  finger  ;  which  has,  from  the  same  conceit,  been  called 
Salvatella.  From  this  source,  we  may  trace  the  basalic ; 
sometimes  in  one  or  two  branches,  or  as  a  plexus,  to  the  ul- 
nar side  of  the  arm, — and  here  it  is  sometimes  called  Ulnaris 
Supcrficialis,  or  Culritalis  Interna. — It  passes  up  by  the  inside 
of  the  tendon  of  the  biceps  ;  there  it  receives  the  median  ba- 
silic. It  then  passes  deep  by  the  side  of  the  artery.  It  is 
sometimes  found  joined  to  the  venae  comites  ;  or  it  passes 
singly  to  the  outside  of  the  tendon  of  the  pectoralis,  and  then 
falls  into  the  axillary  vein. 

On  the  fore  part  of  the  wrist,  we  see  a  plexus  coming 
from  the  thumb  and  palm.  This  plexus  is  frequently  con- 
tinued for  a  considerable  way  up  the  arm,  before  it  forms 


335 

•a  trunk  ;  which  gives  out  branches  both  to  the  basilic  and 
cephalic  ; — the  trunk  is  called  Median,  or  Vena  Superficialis 
Communis.  Near  the  bend  of  the  arm,  it  generally  divides ; 
one  branch  goes  to  the  basilic,  and  ivS  called  Median  Basi- 
lic,, and  the  "other  to  the  cephalic,  and  is  called  Median  Cc- 
phalic*. 

It  is  needless  to  describe  the  deep  veins  of  the  arm,  as  they 
accompany  the  arteries, — whence  they  receive  the  names 
Comites,  or  Satellites  :  there  are  generally  two,  accompany- 
ing each  of  the  principal  arteries. 

We  have  now  traced  the  veins  up  into  the  axilla  ;  here 
the  trunk  is  called  Axillari*:  and  at  this  part,  we  may  trace 
,  branches  into  it  from  the  shoulder,  from  the  scapula  (the  Ex- 
ternal and  Internal  Scapular,}  and  some  from  the  side  (the 
Thoracic  Veins.]  We  may  then  trace  the  vein  under  the 
davicle ;  and  there  it  is  called  Subclavian.  If  we  have  in- 
jected the  great  veins,  we  shall  see  the  union,  on  the  left 
side,  with  the  Internal  Jugular  ;  at  this  angle,  the  thoracic 
duct  enters.  The  great  trunk  may  be  traced  across  the 
chest,  to  unite  with  those  of  the  opposite  side,  to  form  the 
vena  cava  descendens  ;  but  the  manner  of  showing  these  is 
described  more  fully  at  page  242. 


DISSECTION 


NERVES  OF  THE  ARM. 


THE  dissection  of  the  nerves  of  the  arm  may  be  made  on 
the  same  limb  in  which  the  arteries  are  traced. 

The  nerves  which  form  the  Axillary  Plexus,  viz.  the  Four 
Lower  Cervical,  and  .First  Dorsal, '  will  be  found  coming 
from  the  spine,  between  the  scalenus  anticus  and  scalenus 
medius.  These  may  be  dissected  with  the  branches  of  the 
subclavian  artery.  It  is  from  this  plexus  that  all  the  nerves 
pass  to  the  arm.  But  in  dissecting  the  external  part  of  the 
axilla,  we  shall  discover  certain  small  nerves  passing  towards* 
the  pectoralis  major  and  latissimus  dorsi, — these  are  called 
the  Thoracic  Nerves  :  they  are  rather  irregular  in  their 
course,  as  they  occasionally  come  from  the  intercostal  nerve?- 
By  dissecting  deeper,  we  shall  expose  the  great  plexus,  .T?y 


336 

Examining  the  upper  part  of  the  plexus,  we  shall  see  a  nerve 
passing  towards  the  root  of  the  coracoid  process,  viz.  the 
Supra  Scapular  Nerve  ;  which  may  be  traced  through  the 
notch  to  the  supra  spinatus  muscle.  Another  nerve,  the  In- 
fras  Capularis,  will  be  found  passing  from  the  posterior  part 
of  the  plexus  :  it  lies  upon  the  subscapularis,  and  sends  its 
branches  between  this  muscle  and  the  latissimus  dorsi ;  but. 
its  branches  must  not  be  confounded  with  those  of  the  exter- 
nal respiratory r,  which  cross  under  the  plexus,  to  the  serra- 
tus  and  intercostal  muscles. 

If  we  now  pull  out  the  plexus,  and  look  to  the  back  of  it, 
and  immediately  above  the  insertion  of  the  latissimus  dorsi. 
we  shall  find  the  nerve,  which,  from  its  encircling  the  joint?, 
is  called  the  Articular  ;  it  rises  very  frequently  in  common 
with  the  infra  scapular. 

The  other  nerves  which  pass  out  ftom  the  axillary  plexus, 
will  easily  be  recollected  ;  for  there  are  only  three  which  go 
to  the  integuments,  and  three  which  supply  the  muscles  and 
tips  of  the  ringers. 

The  cutaneous  nerves  must  necessarily  be  traced  before 
the  deep  ones.  An  incision  may  be  made  through  the  skin 
only,  in  the  line  of  the  biceps  muscle,  down  to  the  middle  of 
the  fore  arm.  In  dissecting  the  flap,  towards  the  chest,  small 
nerves  will  be  found  coming  through  the  interstices  of  the 
ribs ;  some  of  which  may  perhaps  be  traced  near  to  the  el- 
"bow ;  but  these  intercostal  branches  generally  terminate  on 
the  skin,  a  little  below  the  axilla  :  and  for  the  supply  of  the 
skin,  immediately  below  this  point,  we  shall  find  a  nerve 
that  rises  from  the  most  superficial  part  of  the  inner  side  of 
the  plexus.  As  this  nerve  was  particularly  described  by 
Wrisberg,  it  is  called  th«  Cutaneous  of  Wrisberg.  There  is, 
however,  some  difficulty  in  determining  whether  this  should 
be  considered  as  a  distinct  nerve,  or  as  only  a  branch  of  the 
Internal  Cutaneous  ;  which  will  now  be  seen  rising  from  the 
ulnar  side  of  the  plexus.  The  branches  of  this  last  nerve 
will  afterwards  be  found  to  be  continued  to  the  skin  on  the 
inside  of  the  fore  arm. 

We  may  now  dissect  off  the  other  flap  of  the  skin.  We 
shall  find  no  branches  upon  it  until  we  come  opposite  to  the 
Lead  of  the  brachiaiis  internus  ;  and  there  we  shall  discover 
some  considerable  branches  passing  into  the  skin.  If  we 
trace  these  back  towards  their  origin,  we  shall  find  that  they 
have  come  from  between  the  brachiaiis  and  biceps,  having 
perforated  the  coraco  brachiaiis ;  and  that  they  arise  front 
the  radial,  or  upper  side  of  the  plexus.  The  principal  branch 
having  been  described  by  Casserius  as  the  nerve  which  per- 
forated the  coraco  brachiaiis  muscle,  has  been  called  .thf; 


33t 

jPerforans  CasserU ;  but,  from  its  giving  branches  to  the  co- 
'?aco  brachialis  and  biceps,  as  well  as  to  the  skin,  it  is  some- 
limes  called  the  Muscuh  Cutaneous :.  however,  from  its  rela- 
tive situation  on  the  skin,  it  has  got,  more  commonly,  the 
name  of  External  Cutaneous. 

The  branches  of  the  external  and  internal  cutaneous  should 
now  be  traced  to  their  terminations.  The  external,  as  soori 
as  it  passes  from  below  the  biceps  muscle,  divides  into  three 
branches  upon  the  skin  ;  two  of  which  are  distributed  over 

the  supinators,  while  the  other  passes  down  to  the  wrist . 

The  branches  of  the  internal  cutaneous  may  be  traced  in 
Connexion  with  the  basilic  vein  ;  along  the  course  of  which 
they  pass,  in  three  or  four  branches,  towards  the  wrist.  The 
connexion  of  the  branches  of  both  these  nerves  with  the 
Veins  at  the  bend  of  the  arm,  will  be  fully  described  in  the 
Surgical  Dissection  of  that  part. 

The  three  great  nerves,  the  Radial  or  Median,  the  Ulnar 
and  the  Muscular  Spiral,  may  easily  be  traced  at  the  same 
time  with  the  branches  of  the  arteries.  The  Median  or  Ra- 
dial, will  be  found  to  rise  from  that  division  of  the  plexus 
which  surrounds  the  artery,  and  to  be  often  connected  with 
the  perfbrans  Casserii.  It  may  be  traced  along  the  inside  of 
the  artery,  and  closely  connected  with  it.  When  at  the 
bend  of  the  arm,  it  gives  off  three  branches,  which  supply 
the  muscles  of  the  fore  arm.  But  the  principal  nerve  does 
not  now  run  in  the  course  of  either  of  the  great  arteries,  but 
will  be  found  to  pass  in  the  middle  of  the  fore  arm,  between 
the  flexor  sublimis  and  flexor  profundus  ;  whence  it  is  more, 
properly  called  Median  than  Radial.  It  then  passes  under 
the  annular  ligament ;  but  previous  to  this,  it  generally  givers 
off  some  small  branches  to  the  integuments  upon  the  inside 
of  the  thumb.  In  the  palm  of  the  hand,  it  will  generally  be 
^found  to  divide  into  five  branches, — one  of  which  may  be 
traced  to  the  abductor  and  flexor  pollicis  brevis ;  another  to 
the  adductor  and  side  of  the  thumb  ;  a  third,  to  the  fore  fin- 
ger ;  the  fourth  passes  to  one  side  of  the  fore  and  middle  fin- 
gers ;  and  the  fifth  to  the  other  side  of  the  middle,  and  to 
one  side  of  the  ring  finger  : — besides  these  branches,  lesser 
ones  will  be  found*  passing  into  the  email  muscles  in  the  palm 
&f the  hand. 

The  Ulnar  rises  from  the  lower  and  inner  part  of  the  plex- 
us. The  internal  cutaneous  will  often  be  found  to  be  the  first 
branch  which  it  gives  off.  It  may  then  be  traced  down  be- 
hind the  inner  condyle  of  the  humerus ;  but  before  it  reaches 
this  point,  some  branches  will  be  seen  going  from  it  to  the 
skin  and  triceps  muscle*  Immediately  after  passing  the 
Condyle,  it  gives  a  1  branch  to  the  flexor  muscles  ;-— it  theft 
Ee 


338 

passes  between  the  flexor  carpi  ulnaris  and  flexor  digitorum 
sublimis  :  here  it  will  be  found  to  join  the  ulnar  artery,  along 
which  it  may  be  traced  to  the  wrist.  In  this  course  it  gives 
off  a  few  muscular  branches;  but  when  near  the  wrist,  a 
branch  will  be  found  which  passes  under  the  flexor  carpi  ul- 
naris, and  over  the  lower  end  of  the  ulna,  to  be  distributed  on 
the  back  of  the  hand,  and  on  the  little  and  ring  fingers  :  this 
is  the  Ramus  Posticus. 

The  trunk  of  the  nerve  passes  under  the  annular  ligament, 
into  the  palm, — and  there  it  will  be  found  to  divide  into  two 
principal  branches,  which  are  sometimes  called  the  Sublimis 
and  Profundus.  The  sublimis  may  be  traced  to  the  intern- 
ments on  the  ulnar  side  of  the  hand,  and  to  the  small  muscles 
of  the  little  finger  ;  then,  to  the  sides  of  the  little  finger,  anil 
one  side  of  the  ring  finger.  The  profundus  forms  a  sort 
of  deep  palmar  arm,  to  supply  the  muscles. 

The  Muscular  Spiral  nerve  will  be  found  lying  quite  be- 
hind the  artery,  and  rising  from  the  lower  and  back  part  of 
the  plexus.  It  will  be  seen  to  give  off  many  branches,  al- 
most at  its  origin,  to  the  muscles  contiguous  to  it.  The 
trunk  may  be  traced  along  with  the  profunda  superior  arte- 
ry ;  but  we  may  generally  observe  a  large  branch  rising  from 
it,,  before  it  perforates  the  triceps  ; — this  branch  accompanies 
the  nerve  and  the  artery  for  a  short  distance  ;  it  will  then  be 
found  to  pass  directly  through  the  triceps,  and  to  emerge  up- 
on the  skin,  by  the  side  of  the  supinator  longus,  from  whence 
it  passes,  to  be  distributed  nearly  in  the  same  manner  as  the 
branches  of  the  external  cutaneous. 

The  principal  nerve  may  be  tra-ced  between  the  brachialis 
internus  and  supinator  longus ;  it  there  gives  off*  a  branch  to 
the  elbow,  and  it  then  divides  into  the  profundus  and  superfi- 
dnHs.  The  profundus  may  be  traced  through  the  supinator 
brevis  ;  it  will  then  be  found  to  twist  round  the  radius,  and 
to  divide  into  branches,  for  the  supply  of  the  muscles  on  the 
back  part  of  the  arm.  But  the  other  division,  the  superficial™, 
is  by  far  the  most  important :  it  lies  between  the  supinator 
longus  and  pronator  teres, — from  whence  it  may  be  traced 
between  the  supinator  and  flexor  carpi  radialis,  and  so  close 
upon  the  radial  artery,  that  it  might  be  called  a  radial  nerve : 
when  near  the  wrist,  it  passes  under  the  tendon  of  the  supi- 
nator longus,  and  there  it  lies  directly  over  the  radial  artery, 
viz.  between  the  extensor  muscles  of  the  thumb.  The  nerve 
is,  finally  distributed  on  the  back  of  the  hand,  on  the  back  of 
the  thumb,  fore,  middle  and  ring  fingers. 

In  recapitulation  of  the  nerves  which  arise  from  the  axilla- 
ry plexus,  they  may  be  arranged  thus :  Three  to  the  shoul- 
der,,  viz,  Supra  Scapular^  Infra  Scapufar,  and  Articular. -~ 


339 

Three  to  the  skin  :  External  Cutaneous,  Internal  Cutaneous, 
and  Cutaneous  of  Wrisberg.  Three  to  the  muscles  :  Radial 
or  Median,  Ulnar,  and  Muscular  Spiral, 


SURGICAL  DISSECTION, 


THE  ARM. 


THK  most  important  part  of  this  dissection,  is,  that  of  the 
vessels  about  the  elbow  and  wrist,  for  they  are  liable  to  be 
opened  by  .accidents  which  may  appear  trifling,  but,  if  neglect- 
ed, or  if  treated  by  a  surgeon  who  is  not  fully  master  of  the 
anatomy,  may  he  followed  by  the  most  serious  consequences ; 
sometimes  by  the  loss  of  the  limb,  or  even  by  death. 

The  dissection  of  the  subclavian  artery,  above  the  clavicle, 
should  also  be  most  carefully  made  ;  for  though  it  is  very  im- 
probable that  an  operation  on  the  artery  itself  will  be  follow- 
ed by  success,  still  we  ought  to  know  accurately  the  connex- 
ions which  it  has  with  the  parts  in  its  vicinity, — that  we  may 
be  enabled  to  avoid -it  in  extirpating  tumours,  or  even  to 
take  it  up  for  a  case  of  aneurism.  The  question  of  the  rule 
of  practice,  in  aneurism  of  the  subclavian,  is  very  difficult  to 
determine.  We  shall  find,  by  the  history  of  the  cases  of 
aneurism  of  this  artery,  that  the  relative  position  of  the  parts 
connected  wjth  it,  are  so  changed  by  the  aneurismal  tumour, 
that  even  though  we  may  have  a  very  accurate  knowledge  of 
them  in  their  natural  state,  still  we  may  be  foiled  in  the  at- 
tempt to  take  up  the  artery  when  an  aneurism  has  formed. 
When  it  is  known,  that  even  Sir  Astley  Cooper  has  been 
obliged  to  stop  in  the  middle  of  such  an  operation,  we  may 
be  satisfied  that  it  is  not  a  very  practicable  one  :  his  words 
are,—"  The  clavicle  was  thrust  upwards  by  the  tumour,  so 
as  to  make  it  impossible  to  pass  a  ligature  under  the  artery, 
without  incurring  a  risk  of  including  some  of  the  nerves  of 
the  axillary  plexus  :  the  attempt  was  therefore  abandoned.'' 

The  game  histories  will  also  lead  us  to  doubt  the  proprie- 
ty otVcc/'  attempting  this  operation  ;  for,  in  the  greater  nun> 


34O 

ber  of  cases,  where  even  the  artery  has  been  neatly  tiecf; 
the  vessel  has  ulcerated  above  the  ligature, — and  this,  most 
probably,  in  consequence  of  the  very  short  distance  that 
there  is  between  the  large  trunks,  as  the  passage  of  the 
blood  through  them,  will  necessarily  prevent  the  formation 
of  a  clot  behind  the  ligature, — which  appears  to  be  the  prin- 
cipal source  of  the  great  success  attending  operations  on  the 
external  iliac  and  carotid  arteries.  I  cannot  enter  into  the 
discussion  of  what  should  be  done,  in  aneurism  of  the  subcla- 
vian  ;  but  I  shall  merely  hint  to  the  student,  to  inquire  into 
the  propriety  of  the  proposal  to  remove  the  arm. — To  com- 
prehend the  rationale  of  this  proposal,  he  must  take  into  con- 
sideration the  effect  which  amputation  of  a  limb,  lias  upon 
the  great  artery. 

The  anatomy  of  the  artery  below  the  clavicle,  should  be- 
more  interesting  to  the  student ;  for  the  tying  of  it,  is  a  more 
practicable  operation,  and  has  occasionally  been  attended 

with  success. 1  shall   here  introduce   the   description, 

which  my  friend,  Mr.  Smith,  of  the  Leeds  hospital,  has  given 
of  the  operation,  which  he  performed  on  a  young  girl  who 
had  secondary  haemorrhage  from  the  stump,  after  the  arm 
had  been  torn  off  by  machinery  : — "  One  assistant  compres- 
sed the  artery,  above  the  clavicle  ;  another,  with  the  hand 
upon  the  acromion  process,  depressed  the  shoulder ;  and  a 
third  pressed  a  dossil  of  lint  in  the  stump,  to  restrain  the  he- 
morrhage. I  then  made  an  incision,  from  three  to  four  in- 
ches in  length,  beginning  about  half  an  inch  from  the  ster- 
nal extremity  of  the  clavicle,  and  half  an  inch  below  it,  fol- 
lowing the  course  of  that  bone  towards  the  shoulder.  By 
the  first  incision,  I  divided  the  integuments  ;  and  by  the 
second,  the  clavicular  portion  of  tl/e  pectoralis major:  when 
this  retracted,  the  edge  of  the  pectoralis  minor  was  seen. 
Several  small  arteries  and  veins  were  now  visible,  crossing 
the  course  of  the  artery  :  these  were  tied,  above  and  below, 
before  they  were  divided, — as  the  blood  issuing  from  them, 
would  have  retarded  the  operation.  The  great  vein  was 
then  seen, — and  with  an  appearance  of  pulsation,  caused  by 
the  artery  below  it.  The  artery  was  carefully  separated 
from  it,  for  about  the  third  of  an"  inch,  by  the  handle  of  a 
scalpel ;  the  vein  was  drawn  to  one  side,  by  a  curved  probe ; 
a  directory  was  then  placed  under  the  artery,  to  raise  it  a 
little,  and  a  silk  ligature  was  passed  along  the  groove  of  the 
directory,  by  means  of  an  eyed  probe  :  the  ligature  was  di- 
vided, and  the  probe  withdrawn  ;  to  the  upper  ligature  was 
then  tied  as  high  as  possible,  and  the  other  as  low, — but 
there  was,  still,  just  as  much  space  left,  between  the  liga- 
tures, as  to  allow  of  the  artery  being  divided  with  safety/' 


341 

On  my  questioning  the  utility  of  dividing  the  artery  between 
the  ligatures, — my  friend  agreed  to  my  objections  ;  saying, 
that  he  had  clone  it,  in  compliance  with  the  opinion  of  his 
senior,  as  he  did  not  conceive  any  harm  could  result  from  it. 

The  patient  lived  sufficiently  long,  to  show,  that  the  cali- 
bre of  the  artery  was  properly  obliterated  by  the  ligature: 
she  died  in  consequence  of  haemorrhage  from  the  face  of  the 
stump, — which,  on  dissection,  was  discovered  to  have  come 
from  the  subclavian,  above  the  ligature,  through  the  supra 
scapular  branch  of  the  inferior  thyroid.  This  is  highly  im- 
portant to  recollect ;  because  it  is  a  proof  that  in  a  case  of 
axillary  aneurism,  even  though  the  subclavian  has  been  tied, 
still  the  aneurismal  tumour  may  be  supplied  with  blood  from 
the  anastomosing  branches,  and  may  at  last  burst,  even 
though  the  main  trunk  may  be  obliterated  above  the  aneu- 
rism. 

We  should  now  examine  the  parts  in  the  axilla.  These 
parts  are  so  exceedingly  complicated,  that  no  surgeon  should 
venture  to  operate  upon  them,  unless  he  has  such  a  know- 
ledge, as  will  give  him  boldness  and  decision.  In  making 
the  dissection,  we  should  endeavour  to  keep  the  .parts  as 
much  in  their  natural  situation  as  possible. 

After  laying  bare  the  tendons  of  the  pectoralis  major,  and 
•of  thelatissimus  dorsi,  we  have  to  observe  the  place  of  the 
axillary  glands, — the  size  of  the  branches  of  the  thoracic 
arteries,  and  of  the  scapular, — and  also  the  nerves  which 
come  from  the  intercostal  spaces,  to  pass  amongst  them. 
The  whole  plexus  of  nerves,  and  the  axillary  artery,  will  be 
found  to  be  braced  down  by  a  web  of  aponeuroeis. — When 
this  is  lifted,  wre  shall  find  that  the  nerves  closely  surround 
the  artery  ;  which  shows,  that  the  artery,  when  wounded, 
must  not  be  secured  by  diving  with  a  needle  :  by  such  an 
operation,  the  nerves  would  be  included, — and  the  ligature 
would  not  come  away  until  it  was  cut  from  the  bundle  of 
nerves.  When  the  nerves  and  artery  are  disentangled,  and 
the  divisions  of  the -plexus  are  traced,  we  may  recognize  the 
radial  nerve  running  upon  the  fore  part  of  the  humeral  arte- 
ry ;  the  ulnar  nerve  taking  its  course  towards  the  inner  con- 
dyle  of  the  humerus ;  the  muscular  spiral  nerve  passing 
through  the  triceps,  and  behind  the  bone  ;  the  external  cuta- 
neous nerve  passing  before  the  humerus,  and  through  the  co- 
raco  brachialis.  We  should  then  turn  our  attention  to  the 
circumstance  of  wounds  penetrating  the  axilla  ;  for,  often, 
when  a  ball  has  passed  through  the  arm-pit,  or  when  it  lodg- 
es, the  track,  or  seat  of  it,  may  be  discovered  by  the  numb- 
ness in  the  part  of  the  arm  supplied  by  the  extremities  of  the 
nerve.  Thus,  if  there  should  happen  to  be  a  wound  of  the 
E  e2 


342 

axilla,  attended  with  great  haemorrhage,  and  yet  it  is  nor 
evident  whether  the  axillary  artery  or  the  subscapular  arte- 
ry be  wounded,, — if  we  find  the  muscles  supplied  by  the 
radial  nerve,  to  be  paralytic,  and  the  sensibility  of  the  thumb 
and  fore  and  middle  fingers,  lost,  the  ball,  most  probably,  will 
have  passed  through  the  main  artery,  since  the  radial  nerve 
clings  around  it.  We  may  also  consider  how  the  head  of 
&e  humerus  being  dislocated,  may  press  on  the  plexus  of 
nerves,  or  the  artery,  and  cause  one  symptom  announcing 
dislocation.  The  question  may  pass  through  our  minds. — 
Does  a  punctured  wound  of  the  axillary  artery  call  for  ampu- 
tation ?^— Does  a  wound,  where  the  artery  and  the  whole 
plexus  of  nerves  are  cut  through,  require  amputation?  We 
should  likewise  consider  the  parts  in  the  axilla,  and  the  mus- 
oles  of  the  shoulder,  in  relation  to  the  amputation  of  the  arm 
At  the  shoulder- joint.  We  ought  to  observe  the  great  group 
of  lymphatic,  or  absorbent  glands  of  the  axilla,— for  these, 
when  diseased,  and  clustering  together,  form  a  tumour, 
which  it  is  dangerous  to  extirpate. 

The  most  important  tumour,  is  that  which  is  caused  by 
die  irritation  proceeding  from  the  cancerous  breast.  But 
we  should  recollect,  that,  if  morbid  matter  be  absorbed  in 
the  hand,  buboes  may  be  formed  here,  as  in  the  lymphatic 
if  lands  of  the  groin.  These  cases  are  so  common,  that  we 
may  occasionally  have  opportunities,  in  the  dissecting-room, 
of  examining  them.  We  shall  find  that,  when  the  glands 
are  not  far  advanced  in  disease, — only  feeling  hard  and  en- 
Jarged,  if  a  small  incision  be  made  over  them,  there  is  dan- 
ger of  their  escaping,  by  slipping  amongst  the  loose  cellular 
1  substance. — They  should  be  firmly  fixed  with  the  two  fin- 
gers, so  that  when  the  incision  is  made,  they  may  start  out ; 
or  the  fingers,  should  not  be  removed  from  them,  when  small 
and  moveable,  until  they  are  taken  up  by  the  assistant's 
hook, 

If  the  glands  have  become  much  enlarged,  they  will  form, 
adhesions  with  the  surrounding  cellular  membrane;  and 
they  will  group  together,  forming  a  fixed  indurated  mass, 
(n  such  cases,  we  often  find  numbness  of  the  arm,  and  cede- 
matous  swelling.  The  numbness,  v*e  may  understand  to  bt 
a  consequence  of  the  pressure  on  the  nerves  :  the  swelling  is: 
produced  by  the  disturbance  of  the  absorbents. 

The  dissection  may  now  be  prosecuted  by  taking  the  in- 
teguments  off  the  inside  of  the  arm.  After  recognizing  the- 
muscles  in  this  more  partial  view,  we  ehould  trace^  the 
branches  of  the  humeral  artery  : — we  shall  find  the  radial 
in  company  with  the  main  artery ;  the  ulnar  nerve  ac< 
y  the  pjofunda  interior ;  and  the  piot'unda  sure 


343 

nor,  and  mustular  spiral  nerve,  passing  together  between 
the  heads  of  the  triceps. 

We  should  now  observe  the  manner  in  which  the  hume- 
ral artery,  and  radial  nerve,  and  vence  comites,  are  involved 
in  a  sheath,  and  bound  down  by  a  membrane  ;  and  particu- 
larly, how  they  pass  under  the  stronger  fascia  near  the  bend 
of  the  arm.  We  may  see,  that,  to  cut  for  the  humeral  arte- 
ry, we  have  only  to  lay  bare  the  edge  of  the  biceps  flexor 
cubiti,  to  open  the  sheath,  and  avoid  the  radial  neive  ; — - 
that,  high  in  the  arm,  the  nerve  is  superficial  to  the  artery  ;, 
that,  towards  the  bend  of , the  arm,  it  is  on  the  inside  of  the 
artery. 

The  Full  Anatomy  of  the  Bend  of  the  Arm  is  very  impor- 
tant. The  following  are  the  chief  circumstances  to  be  no- 
ticed* : — 

On  the  fore  part  of  the  arm,  we  should  save  the  superfi- 
cial veins  ;  viz,  the  cephalic  vein,  which  is  coming  upon  the 
radial  edge  ;  the  basilic,  on  the  ulnar  edge  ;  the  median,  in 
the  centre.  We  should  particularly  attend  to  the  divisions 
of  the  median  vein,  which  are  commonly  selected  for  bleed- 
ing ; — and  to  the  manner  in  which  they  are  connected  with 
the  two  superficial,  or  cutaneous  nerves.  Betwixt  the  su- 
pinator  longus,  and  the  outer  edge  of  the  biceps  muscle,  we; 
shall  find  the  external  cutaneous  nerve  :  we  may  trace  its 
branches  under  the  cephalic,  and  median  cephalic  veins- 
The  internal  cutaneous  nerve  will  be  found  coming  directly 
down  from-  the  inside  of  the  arm,  over  the  fascia  :  the  prin- 
cipal branch  goes  under  the  vein ;  but  sometimes  a  small  fila- 
ment passes  over  it.  We  may  now  lift  the  fascia  covering- 
the  humeral  artery,  and  observe  how  thin,  but,  at  the  same 
time,  how  strong  it  is. 

If,  in  bleeding  in  the  median  basilic,  the  lancet  transfixes 
rhe  vein  and  the  fascia,  the  artery  may  be  opened.  The 
consequence  of  such  an  accident  will  most  probably  be,  an 
aneurism, — the  operation  for  which,  must  be  done  by  tying 
the  artery  above  and  below  the  puncture.  The  cases 
which  have  of  late  occurred,  establish  the  propriety  ofthi*. 
operation,  instead  of  that,  of  only  tying  the  artery  above  th& 
wound.  This  same  accident  has  occasionally  produced  the 
varicose  aneurism,  but  not  so  frequently  as  the  common  aneu- 
rism ;  the  progress  and  appearance  of  which,  nearly  corres- 
ponds with  the  following  description  : — 

*  If  a  little  size  injection  be  thrown  into  the  veins, 
will  more  easily  be  made. 


344 

When  the  young  surgeon  opens  the  artery,*  he,  in  great 
alarm,  applies  a  firm  compress  and  roller;  by  which,  the  ex- 
ternal wound,  and  that  of  the  fascia,  soon  heal ;  but  the  ar- 
tery will  continue  to  bleed,  though  not  outwardly ;  the  blood 
will  be  impelled  under  the  fascia  ;  the  connexions  of  the  fas- 
cia will  be  torn  up ;  a  regular  tumour  will  be  formed,  occupy- 
ing the  bend  of  the  arm :  and  this  tumour,  stretching  the 
fascia,  will  contract  the  fingers,  and  keep  the  fore  arm  at  a 
right  angle  with  the  arm,  as  in  other  diseases  in  which  the 
fascia  is  contracted,  or  the  muscles  under  the  fascia  infla- 
med. 

"By  observing  the  anatomy  of  the  parts  here,  we  shall  see 
the  danger  of  tying  the  median  nerve  along  with  the  artery; 
and  the  difficulty  there  would  be,  in  separating  the  nerve 
from  the  artery,  if  the  arm  be  kept  extended.  We  shall  al- 
so see  the  danger  of  cutting  off  cither  the  radial  or  ulnar  ar- 
tery, if,  in  operating  here,  we  dissect  too  boldly.  The  ques- 
tion of  the  inosculations  between  these  several  vessels, 
should  now  pass  through  our  minds.  Nor  should  wTe  forget 
the  irregularities,  that  must  occur  in  the  vessels  here,  when 
there  is  a  high  bifurcation  of  the  humeral  artery. 

A  very  serious  accident  sometimes  occurs  in  bleeding, 
which  our  knowldege  of  anatomy  will  hardly  enable  us  to 
avoid, — the  puncture  of  one  of  the  cutaneous  nerves.  When 
we  examine  the  connexions  of  the  internal  cutaneous  nervff 
with  the  median  basilic,  we  shall  see,  that  the  principal 
branches  pass  under  the  vein  ;  but  if  we  look  to  the  median, 
and  cephalic,  we  shall  find  several  large  branches  from  the 
external  cutaneous,  passing  over  them.  This  view  should 
induce  us  to  prefer  performing  the  operation  of  bleeding  in 
the  median  basilic  vein, — for,  with  a  little  care,  and  a  sharp 
lancet,  the  artery  (which  is  immediately  below  it)  may  be 
avoided  :  but  the  most  dexterous  surgeon  may  prick  one  of 
the  nerves;  the  consequence  of  this,  are  sometimes  terrible. 

We  should  now  pay  particular  attention  to  the  relative 
position  of  the  arteries  and  nerves  in  the  middle  of  the  fore 
wrm  ;  for  the  arteries  are  of  such  a  size,  that,  when  wound- 
ed, they  will  in  general  require  to  be  tied. 

The  radial  artery,  at  about  one-third  down  the  arm,  may 
be  sought  for,  by  first  cutting  through  the  thin  fascia.  By 

*  The  superficial  seat  of  the  artery,  and  its  contiguity  U 
the  vein,  causes  the  blood  to  flow  sometimes  from  the  vein, 
per  saltum  ;  which  circumstance  has  given  a  pale  face  to  ma- 
ny a  youth,  conceiving  it  to  be  the  blood  leaping  from  a 
wound  of  the  artery.  The  pulsation  ceases  upon  bending 
?  he  'arm  a  little. 


345 

then  raising  the  edgaof  the  supinator  longus,  a  second  fas* 
da  will  be  seen,  covering1  the  artery  as  it  passes  over  the  ten- 
don of  the  pronator  teres.  The  same  artery,  near  the  wrist^ 
will  be  found  between  the  flexor  carpi  radialis,  and  the  supi- 
Hator  longus  ;  it  is  covered  Jay  a  fascia  *?  a  considerable  branch 
of  the  muscular  spiral  nerve  will  be  seen  on  its  radial  side; 
and  a  smaller  one,  from  the  external  cutaneous,  almost  im- 
mediately over  it ;  both  of  these  nerves,  are  superficial  to 
the  fascia.  The  artery  will  be  found  on  the  back  of  the 
hand,  between  the  extensor  muscles  of  the  thumb, — but  here 
it  lies  deep  ;  abranch  of  the  muscular  spiral  nerve  crosses  it. 

The  ulnar  artery,  about  the  middle  of  the  fore  arm,  will 
be  found  between  the  flexor  carpi  ulnaris,  and  flexor  digito- 
rum  sublimis,  but  rather  under  the  flexor  sublimis.  The 
ulnar  nerve  lies  on  the  ulnar  side  of  the  artery.  In  looking 
for  the  artery,  near  the  wrist,  we  should  raise  the  fascia 
which  binds  down  the  tendon  of  the  flexor  carpi  ulnaris;  on 
holding  aside  the  tendon,  we  shall  see  another  fascia, — and 
upon  cutting  through  this,  we  shall  find  the  artery.  The 
nerve  is  rather  more  under  the  tendon,  but  still  very  close  to 
the  artery. 

These  are  very  important  points  to  attend  to,— for  I  have 
seen  a  great  deal  of  mischief  arise  in  consequence  of  an  at- 
tempt to  stop  the  bleeding,  of  even  the  superjicialis  voice,  by 
compression.  Two  cases,  in  which  this  small  artery  was 
wounded,  1  well  remember.  A  drunken  fellow,  in  fighting1, 
drove  his  arm  through  a  pane  of  glass;  the  superficialis  vo- 
lae  was  cut,  and  so  near  to  the  main  trunk,  that  it  was  impos- 
sible to  tie  the  stump  of  the  artery.  The  radial  was  tied  ; 
but,  in  consequence  of  the  many  ineffectual  attempts,  which 
had  been  made  in  chemist's  shops,  by  compression,  applica- 
tions of  turpentine,  &c.  the  wound  did  not  heal  kindly  ;  and 
the  man  being  of  a  dissolute  habit,  gradually  sunk.  About 
twelve  months  ago;  I  was  called  to  the  daughter  of  a  respect- 
able tradesman,  who,  in  cutting  bread,  wounded  the  superfi- 
cialis voice.  It  would  appear,  that  the  artery  had  bled  vio- 
lently;  as  she  had  been,  during  the  course  of  two  hours,  sent 
from  shop  to  shop, — until  at  last,  after  having  lost  about  two 
pints  of  blood,  she  found  one  druggist  bolder  than  tho  others; 
who,  however,  to  stop  the  haemorrhage,  resorted  to  such 
means  as  injured  the  arm  so  much,  that  I  found  great  difficult 
ty  in  saving  it.* 

*  A  surgeon  in  the  country  will  find,  that  an  arm,  which 
jias  been  only  partially  dissected,  if  preserved  in  spirits,  (and 
so  that  it  may  be  taken  out  of  the  jar  for  examination,)  will 
to  much  more  useful  tQ  him,  than  the  finest  display 


346 

,  \ 

To  impress  upon  the  student  the  importance  of  the  study 
of  the  surgical  anatomy  of  the  fore  arm,  I  shall  here  intro- 
duce what  Mr.  Charles  Bell  has  said,  in  his  System  of  Dis*- 
sections  : — 

"  Of  the  Ulnar  and  Radial  Arteries  at  the  WrivL  There 
is  no  part  of  the  body  in  which  it  is  more  necessary  to  con- 
nect the  anatomy  with  the  accidents,  than  here  at  the  wrist; 
for,  from  apparently  slight  accidental  wounds  of  these  arte- 
ries, there  come  great  pain,  inflammation,  deep  driving,  of 
the  blood,  unskilful  operations,  and  bad  surgery,  and  dan- 
ger of  losing  the  arm,  and  even  the  life  of  the  patient.  The 
danger  is  from  these  vessels, — the  Ulnar  Artery,  as  it  turns 
aver  the  wrist,  and  the  Radial,  as  it  turns  over  the  root  of  the 
thumb,  or  the  Palmar  Arch  in  the  hand,  not  being  neatly  tied  at 
iirst.  The  consideration  of  this  department  of  surgery§would 
lead  us  too  far  ;  I  only  say,  look  to  it  now,  when  the  parts 
are  before  you.  I  would  beg  you  also,  to  look  to  the  pecu- 
liar appearance  of  the  fat,  and  the  aponeurosis  on  the  palm. 

"  In  a  wound  of  the  artery  in  the  palm,  we  put  in  a  large 
pad  or  compress,  and  close  the  hand,  and  bind  it  firmly ;  but 
if  the  arch  of  the  palm  be  cut,  this  does  not  completely  stem 
frhe  blood, — or  the  pain  and  inflammation  are  such,  as  will 
not  allow  the  bandage  to  be  drawn  sufficiently  tight :  we 
must  then  undo  the  bandage,  and  endeavor  to  find  the  arte- 
ry ;  but  the  appearance  of  the  wound  is  changed:  it  is  tu- 
mid, and  the  cellular  membrane  stuffed  with  blood,  so  that, 
from  the  confusion,  we  probably  cannot  see  the  mouth  of 
the  artery.  In  this  state  of  things,  the  patient  getting  weak 
from  loss  of  blood,  and  the  vessels  perversely  bleeding,  only 
when  the  dressings  are  applied,  and  stopping  when  they  are 
undone,  the  surgeon  is  tempted  to  follow  the  artery  with  in- 
cisions, fruitless  perhaps,  because  he  is  still  amongst  the  dis- 
ordered parts.  He  is  at  last  tempted  to  dive  for  the  roots  of 
those  vessels  with  his  needle.  And  now  let  us  observe  the 
consequence  of  this.  Suppose  that  a  surgeon  does  not  dis- 
sect neatly  for  the  radial  or  ulnar  artery  at  the  wrist,  but 
plunges  for  it  with  his  needle,  the  skin,  tendons,  and  nerves 
are- included,  and  the  ligature  is  drawn  tight  upon  them; 

minute  branches  of  the  arteries.  Such  a.  preparation  will 
not  be  very  expensive,  nor  will  it  be  difficult  to  preserve. — 
After  the  blood  has  been  pushed  out  of  the  vessels,  a  mixture 
of  proof  spirit,  saturated  with  alum,  should  be  injected  into 
them.  A  liquid  composed  of  two-thirds  of  proof  spirit  to 
one  of  distilled  water,  saturated  with  alum,  will  then  be  suffi- 
ciently strong  to  preserve  the  arm  ;  it  mav  be  cut  through 
at  the  middle  of  the  biceps,  and  at  the  middle  of  the  fore  arm-. 


347 

there  maybe  most  dangerous  nervous  symptoms  from  the  "in- 
cluding of  the  nerve,  or,  more  certainly,the  next  day,  by  the 
fading  of  the  parts,  the  ligature  slackens,  and  the  artery 
bleeds  again. 

"  When  the  student  then,  is.  studying  this  part  of  the  anat- 
omy, let  him  not  run  with  too  much  rapidity  over  this  im- 
portant lesson.  I  would  recommend  it  to  him  to  read  Mr. 
John  Bell's  Principles  of  Surgery,  upon  this  point,  where  ho 
will  find  surgical  cases  so  pictured  and  represented  to  him, 
that  he  will  not  quickly  forget  them;  let  him  return  then 
again  to  his  subject ;  let  him  examine  the  fascia  at  the  fore 
part  of  the  wrist,  and  the  manner  in  which  it  covers  the  arte- 
ry :  let  him  observe  the  palmar  aponeurosis,  and  mark  accu- 
rately, the  place  at  which  the  arteries  turn  over  the  wrist  { 
let  him  mark  the  connexion  of  the  ulnar  artery  and  nerve, 
where  they  lie  connected,  and  observe  the  radial  nerve  fre£ 
from  the  arteries,  passing  under  the  ligament  of  the  wrist, 
and  then  he  will  not  be  guilty  of  seeking  the  radial  nerve,  in 
Border  to  separate  it.  from  the  radial  artery." 

The  situation  of  the  nerves  should  be  accurately  marked  '; 
lor  «ases  occasionally  occur,  which  may  induce  us  to  cut  the 
branch  of  one  of  the  nerves  ;  but  the  propriety  of  such  an 
operation,  is  very  questionable.  We  must  not  do  it  in  a  per- 
son who  has  the  slightest  symptoms  of  hysteria,  as  such  cases 
will  probably  be  very  muc&  aggravated  by  the  operation.  I 
was  lately  induced,  by  certain  very  distressing  symptoms, 
which  were  distinctly  referable  to  a  small  tumour  in  a  branch 
of  the  radial  nerve,  to  extirpate  the  tumour;  but  though  the 
local  symptoms  were  removed  by  the  operation,  still  I  would 
not  like  to  repeat  it ;  for  though  my  patient  had  never  pre- 
viously been  hysterical,  she  was  affected,  for  several  days 
-succeeding  the  operation,  by  a  set  of  symptoms,  which 
though  not  actually  alarming,  were  very  unpleasant. 

After  removing  the  muscles,  the  joints  should  be  particu- 
larly examined  with  reference  to  the  subject  of  dislocation. 
In  this  inquiry,  the  student  will  find  much  assistance  in  thfc 
plans  of  the  different  dislocations,  which  are  given  in  the 
operative  surgery,  by  Mr.  Charles  Bell. 


348 

DISSECTION 
OP 

THE  LYMPHATICS. 


THE  dissection  of  the  lymphatics  is  very  easily  made  when 
they  are  injected;  but  to  do  this,  is  perhaps  one  of  the  mdst 
riifficut  operations  of  Practical  Anatomy. 

We  require  for  it  very  delicate  instruments  ;  those  which 
are  sold  in  the  shops,  and  which  are  depicted  in  Sheldon's 
Work  on  the  Absorbents,  are  better  than  the  fine  drawn  glass 
"which  is  recommended  by  the  continental  anatomists  ;  for 
though  the  glass  tube  may  be  made  very  small,  still  it  is  so 
liable  to  break,  that  it  is  a  constant  source  of  vexation. 

Professor  Dumerel  has  proposed  to  show  the  lacteals,  by 
injecting  them  with  milk,  and  then  putting  the  injected  por- 
tion of  intestine  into  a  weak  acid,  by  which  the  milk  will  be 
coagulated  ;  but  the  best  view  of  these  vessels  may  be  given 
by  a  method,  which  a  man  may  be  permitted  to  do  for  once, 
viz.  that  of  tying  the  thoracic  duct  of  an.animal  which  has 
Been  fed,  about  half  an  hour  previous  to  its  death,  upon  meal 
find  milk  : — there  is  no  necessity  for  the  cruel  experiment  of 
tying  the  duct,  and  opening  the  animal  while  alive  ;  for,  as 
the  action  of  the  absorbents  continues  for  a  short  time  after 
the  animal  is  deprived  of  sensibility, — if  the  duct  be  then 
tied,  the  lacteals  will  become  distended. 

In  the  injection  of  the  lymphatics  for  a  preparation,  our 
success  depends,  perhaps,  more  on  the  body  we  choose  than 
on  any  other  circumstance.  It  has  commonly  been  said, 
that  dropsical  bodies  are  the  best  for  making  lymphatic  pre* 
parations  from  ;  but  it  will  be  found,  that  bodies  only  slight- 
fy  anasarcous,  if  they  be  emaciated,  are  much  better.  In  a 
patient  dying  of  consumption,  or  of  any  disease  by  which  the 
fat  of  the  body  has  been  absorbed,  we  shall  perhaps  succeed 
better  than  in  any  other.  It  is  not  merely  on  finding  the 
lymphatics,  and  filling  them  with  mercury,  (for  this  may  be 
done  in  almost  any  body,)  that  the  success  of  the  preparation 
depends,  but  also  on  the  quickness  with  which  the  parts  can 
"be  dried,  after  the  vessels  are  injected. 

In  consequence  of  the  valvular  structure  of  the  lymphat- 
jes,  it  is  necessary  to  inject  from  the  extremities,  toward* 


349 

.link.  In  injecting  an  arm  or  leg,  \vc  ought  to  begin 
as  near  the  ringers  or  toes  as  possible  ;  but  we  need  never 
expect  to  inject  the  lymphatics  as  low  down  as  they  are  re- 
presented in  some  anatomical  plates. 

The  difficulty  of  discovering  lymphatics  is  owing  to  seve- 
ral causes.  Though  they  are  very  small,  still  that  does  not 
so  much  constitute  the  difficulty  as  their  being  generally 
empty  and  transparent.  It  is  advised,  by  some,  to  make  use 
of  magnifying  glasses  ;  but  these  will  be  found  of  little  or  no 
service,  as  it  is  the  transparency  of  the  vessels  that  is  the 
cause  of  their  obscurity.  Small  branches  of  nerves,  and 
small  veiny,  are  very  often  mistaken  for  lymphatics  :  even  a 
person  of  the  most  -experienced  eye  will  not  always  discover 
the  mistake,  until  he  attempts  to  fill  them  with  mercury. 

It  is  almost  in  vain  for  any  one  to  attempt  injecting  lym- 
phatics without  an  assistant ;  for  there  are  so  many  thing.-, 
requisite,  besides  merely  the  holding  of  the  tube  in  the  ves- 
sel, that  he  will  find  he  can  make  but  little  progress  by  him- 
self. 

It  is-  necessary,  before  beginning,  for  the  assistant  to  see 
that  there  are,  within  his  reach,  sharp-pointed  scissars, 
knives,  forceps,  lancets,  pokers,  (for  tubes)  needles  and 
waxed  thread,  so  arranged,  that  they  can  be  used  instantly : 
for  it  will  often  happen,  that  it  will  be  almost  impossible  for 
either  the  assistant  or  the  operator  to  take  his  eye  for  a  mo- 
ment off  the  vessel,  without  losing  it.  It  is  requisite,  also, 
.that  the  assistant  be  very  dexterous;  as  his  office  is  often 
one  of  greater  difficulty,  than  that  of  the  principal  operator. 

Every  tiling  being  arranged,  the  foot  or  hand  is  to  be  pla- 
ced in  a  tray,  that  the  mercury  which  falls,  may  be  caught. 
The  foot  ought  to  be  a  little  more  elevated  than  the  groin,  to 
assist  the  flow  of  the  mercury  towards  that  part.  With  a 
sharp  scalpel,  a  portion  of  the  skin  is  to  be  cut  off  horizon- 
tally, so  as  to  expose  the  loose  cellular  texture  ;  for  in  this 
texture,  are  the  superficial  lymphatics  generally  situated. 
If  we  cannot  find  one  near  the  toes  (which  is  very  often  the 
case)  we  shall  probably  discover  one  running  across  the  sa- 
phena  magna,  on  the  instep.  We  must  then  take  hold  of  it 
with  the  forceps,  and  dissect  it  from  the  surrounding  sub- 
stance  (to  secure  the  keeping  of  it,  we  should  put  a  needle 
with  a  fine  waxed  thread  under  it.)  Having  still  hold  of  the 
vessel  with  the  forceps,  we  should  snip  it  half  across  with  fine 
scissars, — and  into  the  cut  made  by  the  scissars,  introduce 
the  fine  poker  which  is  made  for  clearing  the  pipes.  We 
should  now  take,  from  the  assistant's  hand,  the  tube  con  - 
taining  the  mercury,  with  the  stop-cock  already  turned, 
and  let  the  stream  of  mercury  play  on  the  side  of  the  poker,;  f 


350 

which  will  generally  so  direct  the  stream,  that  it  will  cuter 
the  vessel.  When  once  we  have  succeeded  in  getting  a  few 
drops  of  mercury  into  the  lymphatic,  it  will  be  easy  to  get 
the  pipe  into  the  open  mouth  of  the  vessel,  and  then  the  po- 
Icer  may  be  withdrawn. 

There  is  an  apparent  clumsiness  in  this  method  of  filling 
the  vessels  :  but  in  this  manner,  the  smallest  vessels  may  be 
injected, — when  it  will  be  found  quite  impossible  to  inject 
them  in  the  old  way,  of  puncturing  the  lymphatic  with  a  lan- 
cet, and  introducing  the  point  of  the  tube  into  it.  The  scis- 
sors make  a  better  kind  of  cut  than  the  lancet ;  though  there 
is  a  great  deal  of  nicety  required  in  using  them,  as  they  are 
liable  to  cut  the  vessel  completely  through.  The  poker  is 
of  very  great  service,  as  by  it,  it  is  always  possible  to  know* 
whether  it  is  a  lymphatic  or  a  small  nerve  that  we  have  got : 
if  it  be  a  lymphatic,  the  poker  will  pass  on  smoothly  ;  if  a, 
nerve,  it  will  tear  it  into  fibres.  When  introduced  into  a. 
lymphatic,  it  holds  aside  the  lips  of  the  cut,  so  that  the  mer- 
cury passes  into  the  vessel,  by  the  side  of  it. 

If  the  vessel  into  which  the  pipe  is  introduced,  be  large,  it 
ought  to  be  tied,  round  the  pipe,  with  the  thread  which  was 
previously  put  under  it.  The  mercury  is  to  be  pressed  on,  by 
the  assistant,  with  the  handle  of  the  knife;  for  the  injector 
ought  never  to  take  his  eye  off  the  pipe,  but  he  should,  accor- 
ding to  the  direction  of  his  assistant,  elevate  or  depress  the 
tube  containing  the  mercury, — which  will  regulate  the  force 
of  the  injection.  The  mouth  of  the  vessel  ought  to  be  mois- 
tened at  intervals,  to  prevent  its  getting  dry,  which  impedes 
the  flow  of  the  mercury. 

If  the  lymphatic  into  which  we  have  introduced  the  pipr. 
has  filled  a  considerable  number  of  vessels  on  the  thigh,  tln> 
mercury  is  then  to  be  pressed  on  to  the  glands  in  the  groin, 
taking  care  that  the  foot  is  not  too  much  elevated ;  as  by  that, 
the  column  of  mercury  would  be  raised  higher  than  the  ves- 
sels in  the  glands  could  bear,  especially  as  the  lymphatic* 
there,  seem  to  be  more  easily  burst,  than  at  any  other  psrt. 

We  should  now  withdraw  the  pipe,  and  look  for  other  lym- 
phatics on  the  ancle,  and  proceed  with  them  in  the  same  man- 
ner. 

fr  the  glands  are  not  completely  filled,  we  ought  to  endea- 
vour to  find  the  vessel  that  has  the  most  influence  in  filling* 
each  gland, — for  there  generally  appears  to  be  one  vessel 
which  fills  the  gland  more  quickly  than  the  others ;  and  at- 
•;r  securing  the  other  vessels,  we  should  fill  the  gland  from 
If  we  wish  to  make  a  good  display  of  the  glands  at  th'.t 
n,  we  ought  to  tie  the  seconclarv  vessels  arising  frcin 


351 

i.hem ;  as  the  mercury  often  passes  into  tlic  secondary  ves- 
sels, before  it  fills  the  gland  itself. 

The  vessels  ought  to  be  dissected  and  dried  as  quickly  as 
possible ;  for  if  the  limb  becomes  putrid,  the  mercury  in  the 
lymphatics  is  liable  to  become  black.  After  exposing  them, 
and  before  they  are  dried,  they  ought  to  be  tied  at  regular 
intervals  ;  they  should  always  be  kept  in  the  horizontal  po- 
sition, as  they  are  liable  to  burst  when  dry,  if  held  perpen- 
dicularly. We  may  generally  succeed  in  injecting  the  lym- 
phatics of  the  liver,  or  the  lacteals  of  the  intestines,  by  mere- 
ly puncturing  the  vessels  with  the  lancet ;  for  there  is  here, 
u  surface  opposed  to  the  vessels,  which  keeps  them  more 
steady,  than  those  in  the  limbs. 

By  blowing  air  into  the  lymphatics,  we  may  inject  them 
more  easily  f  but  there  is  always  the  disadvantage  attending 
this  method,  that  the  air  prevents  the  flow  of \he  mercury 
into  the  glands. 

These  preparations  are  attended  with  so  much  trouble  in 
the  making,  that  it  is  of  some  consequence  to  be  able  to  pre- 
serve them.  If  we  endeavour  to  do  this,  by  merely  varnish- 
ing and  drying  them,  we  shall  soon  see  our  labour  defeated ; 
for  the  change  from  the  horizontal  position,  or  a  change  of 
temperature,  will,  in  all  probability,  burst  the  vessels.  By 
preserving  them  in  spirits  of  turpentine,  we  shall  riot  only 
avoid  the  changes  of  temperature,  and  the  destruction  by  in- 
sects, but  add  much  to  the  beauty  of  the  preparations. (a) 

(a)  The  lymphatics,  for  the  most  part,  take  the  course  of 
the  veins  from  which  we  have  a  superficial  and  a  deep  seat- 
ed set.  The  superficial  lymphatics  run  immediately  under 
the  common  integuments:  those  of  the  extremities  are  on 
the  inner  side  of  the  limb,  and  are  more  numerous  than  the 
veins  in  those  places  situated.  The  deep  seated  absorbents 
accompany  the  ramifications  of  the  large  arteries,  and  are 
lull  double  their  number. 

The  student,  by  a  reference  to  some  system  of  anatomy, 
will  acquaint  himself  with  the  course  of  the  absorbents 
throughout  the  body  before  he  may  attempt  the  injection  of 
a  single  limb.  He  should  be  well  acquainted  where  to  look 
for  these  vessels,  since,  when  exposed  to  the  eye,  they  are 
with  such  difficulty  distinguished. 

While  on  the  examination  of  the  parts  concerned  in  femo= 
ral  hernia,  the  student,  if  he  introduce  the  pipe  into  the  lym- 
phatics at  the  inner  pait  of  the  thigh,  where  the  vessels  are 
large  and  easily  found,  may  nave  a  sight  of  the  superficial 
absorbents,  that,  by  perforating  the  crural  sheath;  give  the 


352 

appearance  called  cribriform  portion  of  that  sheath.  From 
this  source,  by  a  little  care,  the  glands  of  the  groin  may  be 
filled,  and  all  the  trunks  of  the  absorbents  seen  as -they  pass 
under  Poupart's  ligament.  By  this  he  will  be  able  to  see 
the  part  by  which  a  femoral  hernia  appears  at  the  upper  part 
of  the  thigh,  and  have  a  full  view  of  the  cause  that  weakens 
the  sheath  at  its  inner  and  upper  part. 


EXPLANATION  OF  THE  PLATES, 


INDEPENDENTLY  of  the  truth  or  philosophy  of  Mr.  BellV 
observations  on  the  nervous  system,  we  have  at  present  t<» 
consider  it  as  an  arrangement  merely, — as  a  plan  -for  facili- 
tating the  acquirement  of  a  knowledge  ofthe  nerves. 

When  we  contemplate  the  dissection  which  we  have  made 
ofthe  nerves  of  the  face,  neck  and  chest,  and  arc  lost  in  the 
confusion  ofthe  Vllth,  VHIthand  IXth,— of  the  branches  of 
the  cervical  nerves,  ancl  of  the  sympathetic, — ofthe  diaphrag- 
matic and  spinal  accessory  nerves,  we  shall  be  prepared  to 
eee  the  advantages  ofthe  plans  which  are  annexed.  I  think 
the  student  will  soon  discover  that  the  system,  of  which  the 
plans  may  give  him  some  idea,  is  not  only  a  most  remarkable 
improvement  in  the  knowledge  of  the  structure  and  func- 
tion of  animal  bodies,  but  is  of  the  greatest  use  in  practical 
anatomy,  by  facilitating  the  comprehension  of  a  very  useful, 
department. 

The  principal  arrangement  is  this  : — there  is  an  obvious 
division  of  the  medulla  spinalis,  corresponding  to  the  cere- 
brum and  cerebellum  ; — every  Regular  Jferve  has  two  roots, 
one  from  the  anterior  of  these  columns,  and  another  from  the 
posterior.  Such  are  the  Vth  pair ;  the  Suboccipital ;  the 
Seven  Cervical  ;  the  Twelve  Dorsal  ;  the  Five  Lumbar  ;  ancl 
the  Six  Sacral^  viz.  thirty-two  Perfect,  Regular,  or  Double 
vVerirc.y.  These  are  laid  down  in 'the  first  plan.  They  are 
common  to  all  animals,  from  the/worm  up  to  man  ;  ami  are 
for  the  purposes  of  common  sensation  and  motion,  or  voli- 
tion. They  run  out  laterally  to  the  regular  divisions  of  the 
body,  and  never  take  a  course  longitudinal  to  the  body. 

For  the  sake  of  an  arrangement  (although  the  term  be  not 
correct  where  every  thing  is  perfect,)  the  remaining  nerves 
are  called  Irregular  Nerves.  These  are  distinguished  by  a 
simple  fasciculus,  or  single  root;  that  is,  a  root  from  on* 
column.  These  are  imperfect  in  their  origins,  irregular  m 
their  distribution,  and  deficient  in  that  symmetry  which  char- 
acterizes the  first  class.  They  are  superadded  to  the  origi- 
nal class,  and  correspond  to  the  number  and  complication  o; 
the  superadded  organs.  Of  these,  there  are — the  Hid,  IVth, 
and  Vlth,  to  the  eye  ;  the  Vllth,  to  the  face;  the  IXtli 


354 

1  he  tongue;  the  Gfosso  Pharyngeal,  to  the  pharynx  ;  the 
Vagus,  to  the  larynx,  heart,  lungs,  and  stomach  ;  the  Phre- 
nic, to  the  diaphragm  ;  the  Spinal  Accessory,  to  the  muscles 
of  the  shoulder  ;  the  External  Respiratory,  to  the  outside  of 
the  chest. 

If  we  inquire  into  the  reason  of  this  seeming  confusion  in 
the  second  class,  or  irregular  nerves,  we  shall  perceive,  that 
it  is  owing  to  the  complication  of  the  superadded  apparatus 
of  respiration,  and  the  variety  of  offices  which  this  apparatus 
has  to  perform  in  the  higher* animals.  To  explain  this,  the 
second  plan  is  given.  It  presents,  in  one  view,  the  nerves' 
destined  to  move  the  muscles  in  all  the  varieties  of  respira- 
tion, speech  and  expression. 

We  may  now  see  how  confounding  the  nwnbcruig  of  the 
nerves,  according  to  the  system  of  Willis,  is  ;  and  how  im- 
possible it  is  to  make  a  natural  arrangement,  while  the 
nerves  are  so  numbered. 


PLATE  I. 

A. A.  Cerebrum. 
B.B  Cerebellum. 
•C.C.  Crura  Cerebri. 
D.D.  Crnra  Cerebelli. 
E.E.E.  Spinal  Marrow. 

1. 1.  Branches  of  the  Vth  pair,  or  Trigemimis,  which  are 
seen  to  arise  from  the  union  of  the  Crura  Cerebri  and 
Crura  Cerebelli  and  to  have  a  ganglion  at  the  roots.. 

3.  2.  Branches  of  the  Subcjccipital  Nerves,  which  have  double 
origins  and  a  ganglion. 

3.  3  The  branches  of  the  four  Inferior  Cerviclc  Nerves,  and 
of  the  first  Dorsal,  forming  the  Axillary  Plexus :  the  ori> 
gins  of  these  Nerves  are  similar  to  those  of  the  Vth  and 
the  Suboccipital. 

•1.  4. 4. 4.  Branches  of  the  Dorsal  Nerve.c;  which  also  arise  in 
the  same  manner. 

3. 5.  The  Lumbar  Nerves, 
&.  6.  The  Sacral  Nerves. 


355 

PLATE"  IL 

A.  CEHEBBVM. 

B.  CEREBELLUM. 
C.C.C.  SPINAL  MARROW. 

D.  TONGUE. 

E.  LARYNX. 
P.  LUNGS. 
G.  HEART. 
H.  STOMACH. 
I.  DIAPHRAGM. 

1.1.1.  PAR  VAGUM,  arising  by  a  single  set  of  roots,  am! 
passing  to  the  larynx,  the  lungs,  heart  and  stomach. 

2.  Superior  Laryngcal  Branches  of  the  Par  Vagum. 

3.  Recurrent,  or  Inferior  Laryngeal  of  the  Par  Vagum. 

4.  Pulmonic  Plexus  of  the  Par  Vagum. 

5.  Cardiac  Plexus  of  the  Par  Vagum. 

6.  Gastric  Plexus,  or  Corda  Ventriculi  of  the  Par  Vagurn. 

7.  RESPIRATORY  NERVE,  or  Portw  Dura,  to  the  Muscles  <*.«' 
the  Face,  arising  by  a  series  of  single  roots. 

8.  Branches  of  the  GLOSSO  PHARYNGEAL. 

9.  LINOTTALIS,  sending  branches  to  the  Tongue  and  to  UK 
Muscles  on  the  forepart  of  the  larynx. 

10.  Origins  of  the  SUPERIOR  EXTERNAL  RESPIRATORY,  or 
8pinal  Accessory. 

11.  Branches  of  the  last  Nerve,  to  the  Muscles  of  the  shou"! 
der. 

12. 12. 12.  INTERNAL  RESPIRATORY,  or  the  Phrenic,  to  thr» 
Diaphragm.  The  origins  of  this  nerve  may  be  seen  lit 
pass  much  higher  up,  than  they  are  generally  described. 

'3.  INFERIOR  EXTERNAL  RESPIRATORY,  to  the  Muscles'  on 
therid&cfthe  Chest. 


FINIS. 


U.C.  BERKELEY  LIBRARIES 


,1 


